Department of Children and Adolescents, Oulu University Hospital, PO Box 23, 90029, Oulu, Finland.
Pediatr Nephrol. 2012 Jun;27(6):933-9. doi: 10.1007/s00467-012-2106-z. Epub 2012 Feb 5.
Corticosteroids have been shown not to prevent the development of Henoch-Schönlein nephritis. However, long-term follow-up data are scarce.
The long-term outcome of patients in a randomized placebo-controlled prednisone study was evaluated 8 years later with a health questionnaire completed by 160/171 (94%) patients and by urine and blood pressure screening (138/171, 81%).
Twelve patients had hematuria and/or proteinuria and seven had hypertension. The patients with nephritis at onset of Henoch-Schönlein purpura (HSP) had an increased risk of hypertension and/or urine abnormalities (odds ratio 3.6, p = 0.022, 95% confidence interval 1.3-10.0). There were no differences between the prednisone and placebo groups. Recurrences of purpura were reported by 15 patients, with some recurrences continuing for 10 years. All five reported pregnancies were complicated by proteinuria. Four patients presented with hematuria and/or proteinuria at the control visit, and four had hypertension. Of these, two had a decreased estimated glomerular filtration rate.
HSP has a good long-term prognosis in unselected patients, although skin relapses with/without late-onset nephritis may occur, even a decade after the initial disease. Urine and blood pressure abnormalities 8 years after HSP are associated with nephritis at its onset. Early prednisone treatment does not affect the outcome and should not be routinely used.
皮质类固醇已被证明不能预防过敏性紫癜肾炎的发生。然而，长期随访数据很少。
对接受随机安慰剂对照泼尼松治疗的患者进行了 8 年的长期随访，171 名患者中有 160 名（94%）完成了健康问卷，138 名（81%）接受了尿和血压筛查。
12 名患者出现血尿和/或蛋白尿，7 名患者出现高血压。过敏性紫癜发病时伴有肾炎的患者发生高血压和/或尿液异常的风险增加（比值比 3.6，p=0.022，95%置信区间 1.3-10.0）。泼尼松组和安慰剂组之间没有差异。15 名患者报告有紫癜复发，其中一些复发持续了 10 年。报告的所有 5 例妊娠均伴有蛋白尿。4 名患者在随访时出现血尿和/或蛋白尿，4 名患者出现高血压。其中 2 名患者肾小球滤过率估计值降低。
在未选择的患者中，过敏性紫癜具有良好的长期预后，尽管皮肤复发伴/不伴有迟发性肾炎可能会发生，甚至在最初疾病发生 10 年后也是如此。HSP 8 年后的尿和血压异常与发病时的肾炎有关。早期泼尼松治疗不会影响结局，不应常规使用。
