Tanaka Hiroshi, Suzuki Koichi, Nakahata Tohru, Ito Etsuro, Waga Shinobu
Department of Pediatrics, Hirosaki University School of Medicine, Hirosaki, Japan.
Pediatr Nephrol. 2003 Apr;18(4):347-50. doi: 10.1007/s00467-003-1094-4. Epub 2003 Mar 28.
Nine Japanese children with severe proteinuric Henoch-Schönlein purpura nephritis (HSPN) received prompt initiation of oral prednisolone (1.5 mg/kg/day) combined with an 8-week course of cyclophosphamide (2 mg/kg/day) therapy. All underwent renal biopsy before and after treatment. At presentation, urine protein excretion and histologic indices of the mean activity index, the mean chronicity index and the tubulointerstitial (TI) scores in the patients were 5.0+/-1.4, 4.7+/-1.0, 3.9+/-1.6 and 3.7+/-0.5 g/day, respectively. Urine protein excretion, the activity index and the TI scores decreased significantly at the second renal biopsies obtained at a mean interval of 23 months after the first [0.3+/-0.3, 2.4+/-0.5 and 1.4+/-0.7 g/day ( P<0.01), respectively], while the chronicity index did not change. At the latest observation (mean interval 78 months), all except two showed negative proteinuria while no patient showed renal impairment. Although this case series is without controls, our experience suggests that early treatment with oral prednisolone and cyclophosphamide may be beneficial to a proportion of patients with severe proteinuric HSPN.
9名患有严重蛋白尿性过敏性紫癜性肾炎（HSPN）的日本儿童迅速开始口服泼尼松龙（1.5毫克/千克/天），并联合进行为期8周的环磷酰胺（2毫克/千克/天）治疗。所有患儿在治疗前后均接受了肾活检。就诊时，患者的尿蛋白排泄量以及平均活动指数、平均慢性指数和肾小管间质（TI）评分的组织学指标分别为5.0±1.4、4.7±1.0、3.9±1.6和3.7±0.5克/天。在首次肾活检后平均23个月时进行的第二次肾活检中，尿蛋白排泄量、活动指数和TI评分显著下降[分别为0.3±0.3、2.4±0.5和1.4±0.7克/天（P<0.01）]，而慢性指数未发生变化。在最近一次观察时（平均间隔78个月），除两名患者外，所有患者均表现为蛋白尿阴性，且无患者出现肾功能损害。尽管该病例系列没有对照组，但我们的经验表明，早期口服泼尼松龙和环磷酰胺治疗可能对一部分严重蛋白尿性HSPN患者有益。
