Background Henoch-Schonlein purpura (HSP) is a disease with small blood vessels inflammation. Although HSP can affect people at any age, most cases occur in children between the ages of 2 and 11. The disease involves skin, intestines, kidneys, and joints. The main symptom is a rash with numerous small bruises, which have a raised appearance, over the legs or buttocks. Almost 30-40% of children with HSP may have renal involvement. In most patients, the kidney impairment is mild and goes away without any long-term damage. However, about 5% of patients may develop progressive kidney disease and 1% may go on to end stage renal disease (ESRD).
Objectives To date, treatment of HSP remains primarily supportive in most cases. Hematuria at disease onset and persistence of renal manifestations during the occurrence of HSP can be significant predictors of possible development of renal sequelae. These manifestations, along with other features may predict the development of renal sequelae in most patients. Various drugs have been used to prevent renal disease from progressing. The results have been inconsistent. The aim of our study was to evaluate the efficacy of pulsed Methylprednisolone in children with HSP and renal manifestation.
Methods 69 children with HSP who had HSP and were admitted to Mofid Children's Hospital were evaluated; Children who had the indication of treatment were received 30mg/kg of Methylprednisolone for three consecutive days instead of traditionally oral prednisolone therapy. All of children were followed for ten years and evaluated for renal involvement.
Results Of 69 patients with HSP, 55 children full filed the indication of therapy and were received pulsed methylprednisolone. Only 6 patients had the renal manifestation but no ESRD. Only one patient had persistent renal disease that was treated by Cyclophosphamide.
Conclusions The previous results showed that 30-40% of children with HSP may have renal involvement and about 5% of patients may develop progressive kidney disease. Our 10 years follow up showed that only 10% of children who were admitted to Hospital and were received pulse of Methylprednisolone, had renal involvement. None of 69 patients suffered ESRD.
We suggest limiting the indications of steroid therapy for children with HSP. However, if the patients need to receive steroid therapy, pulse of Methylprednisolone may reduce the latent renal complications.
Disclosure of Interest None declared