Counahan R, Winterborn M H, White R H, Heaton J M, Meadow S R, Bluett N H, Swetschin H, Cameron J S, Chantler C
Br Med J. 1977 Jul 2;2(6078):11-4. doi: 10.1136/bmj.2.6078.11.
All the survivors of a series of 88 patients with Henoch-Schönlein nephritis were examined after a follow-up of six and a half to 21 years (mean 9-9). Sixty-one patients had no demonstrable abnormality; six had minor urinary abnormalities; five had hypertension without urinary abnormally or renal dysfunction; four had heavy proteinuria; eight were in chronic renal failure, three of whom were on regular dialysis; and four patients had died within 25 months of onset. Neither corticosteroids nor immunosuppressive drugs alone or in combination appeared to influence the outcome. A clinical presentation with a combination of acute nephritis and a nephrotic syndrome and a high proportion of crescents in renal biopsy specimens was associated with a poor outcome. Neither the clinical presentation nor the renal morphology were, however, precise determinants of outcome. Outcome was not related to age, associated streptococcal infection, or recurrences of the rash. The clinical state two years after presentation was compared with the state six and a half years or more after presentation in 76 patients. The clinical state had changed in 32 patients, in 17 of whom it had deteriorated. It was not possible to identify with any certainty the patients who would deteriorate (or improve). Patients who have had Henoch-Schönlein nephritis should be followed up for at least five years.
对88例紫癜性肾炎患者进行了随访，随访时间为6年半至21年（平均9.9年），对所有幸存者进行了检查。61例患者未发现明显异常；6例有轻微尿液异常；5例有高血压但无尿液异常或肾功能不全；4例有大量蛋白尿；8例处于慢性肾衰竭，其中3例接受定期透析；4例患者在发病后25个月内死亡。单独使用或联合使用皮质类固醇和免疫抑制药物似乎均未影响预后。临床表现为急性肾炎和肾病综合征合并，且肾活检标本中新月体比例高，提示预后不良。然而，临床表现和肾脏形态均不是预后的精确决定因素。预后与年龄、相关链球菌感染或皮疹复发无关。对76例患者就诊两年后的临床状态与就诊6年半或更长时间后的状态进行了比较。32例患者的临床状态发生了变化，其中17例病情恶化。无法确切识别出病情会恶化（或改善）的患者。患有紫癜性肾炎的患者应至少随访5年。
