Successful therapy with tonsillectomy for severe ISKDC grade VI Henoch–Schönlein purpura nephritis and persistent nephrotic syndrome

• Published in: Clinical and experimental nephrology Vol. 15; no. 5; pp. 749 - 753
• Main Authors: Ohara, Shinichiro, Kawasaki, Yukihiko, Matsuura, Hiromi, Oikawa, Tomoko, Suyama, Kazuhide, Hosoya, Mitsuaki
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.10.2011; Springer Nature B.V
• Subjects: Adolescent; Case Report; Female; Humans; Medicine; Medicine & Public Health; Methylprednisolone - administration & dosage; Nephritis - drug therapy; Nephritis - surgery; Nephrology; Nephrotic Syndrome - drug therapy; Nephrotic Syndrome - surgery; Plasmapheresis; Proteinuria - drug therapy; Proteinuria - surgery; Pulse Therapy, Drug; Purpura, Schoenlein-Henoch - drug therapy; Purpura, Schoenlein-Henoch - surgery; Tonsillectomy; Treatment Outcome; Urokinase-Type Plasminogen Activator - administration & dosage; Urology; Tonsillectomy methylprednisolone and urokinase pulse; Henoch–Schönlein purpura nephritis; Nephrotic syndrome; Plasmapheresis
• ISSN: 1342-1751; 1437-7799
• DOI: 10.1007/s10157-011-0463-8

Henoch–Schönlein purpura (HSP) is a systemic disorder characterized by leukocytoclastic vasculitis involving the capillaries and the deposition of IgA immune complexes. Renal involvement is the principal cause of morbidity and mortality in children with HSP. We report here a 13-year-old girl with Henoch–Schönlein purpura nephritis (HSPN) of International Study of Kidney Disease in Children (ISKDC) grade VI and persistent nephrotic syndrome despite receiving conventional therapy, such as prednisolone, methylprednisolone and urokinase pulse therapy and plasmapheresis (PP). The patient was treated with tonsillectomy, which subsequently decreased proteinuria, induced the disappearance of microscopic hematuria, and improved renal pathological findings. A regimen of methylprednisolone and urokinase pulse therapy plus PP with tonsillectomy may be an effective and useful therapy for some children with severe HSPN children of ISKDC grade VI and persistent nephrotic syndrome.