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Objective. Renal involvement in Henoch–Schönlein purpura (HSP) constitutes a risk of end-stage renal disease (ESRD), especially in patients presenting with nephrotic syndrome. Patients and methods. The clinical courses of six patients (mean age 13.2 years; four boys and two girls) admitted from 2000 to 2007 with HSP and nephrotic syndrome were reviewed. Average follow-up was 44 months (28–59). Treatment protocols included oral prednisolone and in non-responders cyclosporin A, cyclophosphamide, mycophenolate mofetil or tacrolimus. Five patients were treated immediately after presentation of nephrotic syndrome/nephrotic range proteinuria (median 277 mg/m²/h). The last patient was treated locally with low-dose prednisolone (0.2–0.9 mg/kg/day) and 3 months of low-dose cyclophosphamide (1 mg/kg/day). Results. All five patients treated promptly with high-dose immunosuppressant had normal …