Bayrakci Umut S, Topaloglu Rezan, Soylemezoglu Oguz, Kalyoncu Mukaddes, Ozen Seza, Besbas Nesrin, Bakkaloglu Aysin
Department of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
J Nephrol. 2007 Jul-Aug;20(4):406-9.
Henoch-Schönlein purpura (HSP) is a systemic, small vessel vasculitis, which is very common among pediatric population. Findings of previous reports addressing the preventive effect of corticosteroid treatment in HSP nephritis have been inconsistent. The aim of this study was to determine whether corticosteroid therapy was effective in preventing Henoch-Schönlein nephritis.
The medical records of 216 children with HSP, seen in 2 tertiary care pediatric nephrology centers, were reviewed retrospectively. The effect of corticosteroid therapy on preventing nephritis was assessed in 157 patients who had no evidence of nephritis at the initial urinalysis. The treatment group (n=61) had received oral corticosteroids for gastrointestinal symptoms and/or arthritis. The dosage of prednisone was 1 mg/kg per day for 1-2 weeks, with weaning over a week. We compared the rate of renal involvement during follow-up between the groups who were treated with corticosteroids and not.
Nephritis developed in 17 of the 61 (27.8%) corticosteroid-treated patients and 18 of the 96 (18.7%) untreated patients during follow-up.
There was no evidence that corticosteroids reduced the risk of renal involvement in HSP, and these results do not support the use of corticosteroids in early HSP to prevent renal injury.
过敏性紫癜（HSP）是一种全身性小血管炎，在儿童群体中非常常见。以往关于皮质类固醇治疗对HSP肾炎预防效果的报告结果并不一致。本研究的目的是确定皮质类固醇疗法在预防过敏性紫癜肾炎方面是否有效。
回顾性分析了2家三级儿科肾病中心收治的216例HSP患儿的病历。对157例初始尿液分析无肾炎证据的患者评估皮质类固醇疗法对预防肾炎的效果。治疗组（n = 61）因胃肠道症状和/或关节炎接受了口服皮质类固醇治疗。泼尼松剂量为每日1 mg/kg，持续1 - 2周，并在一周内逐渐减量。我们比较了接受皮质类固醇治疗组和未接受治疗组在随访期间肾脏受累的发生率。
在随访期间，61例接受皮质类固醇治疗的患者中有17例（27.8%）发生肾炎，96例未治疗患者中有18例（18.7%）发生肾炎。
没有证据表明皮质类固醇可降低HSP患者肾脏受累的风险，这些结果不支持在早期HSP中使用皮质类固醇预防肾损伤。
