التفاصيل البيبلوغرافية
| العنوان: |
Methylprednisolone or cyclosporine a in the treatment of Henoch-Schönlein nephritis: a nationwide study. |
| المؤلفون: |
Koskela, Mikael1,2 mikael.koskela@helsinki.fi, Jahnukainen, Timo2, Endén, Kira3, Arikoski, Pekka4, Kataja, Janne5, Nuutinen, Matti6,7, Ylinen, Elisa2 |
| المصدر: |
Pediatric Nephrology. Aug2019, Vol. 34 Issue 8, p1447-1456. 10p. 1 Diagram, 5 Charts, 2 Graphs. |
| مصطلحات موضوعية: |
*ACE inhibitors, *IMMUNOSUPPRESSIVE agents, *PROTEINURIA, *METHYLPREDNISOLONE, *ANGIOTENSIN receptors, *CHRONIC kidney failure, *CONFIDENCE intervals, *CYCLOSPORINE, *GLOMERULAR filtration rate, *HEMATURIA, *KIDNEYS, *KIDNEY diseases, *NEPHRITIS, *MEDICAL records, *ORAL drug administration, *PEDIATRICS, *PREDNISONE, *URINALYSIS, *RELATIVE medical risk, *TREATMENT effectiveness, *SCHOENLEIN-Henoch purpura, *ACQUISITION of data methodology, *THERAPEUTICS, *DISEASE risk factors |
| مصطلحات جغرافية: |
FINLAND |
| مستخلص: |
Background: Optimal treatment of Henoch-Schönlein purpura nephritis (HSN) remains unclear. We evaluated outcome of pediatric HSN patients treated initially with either methylprednisolone (MP) or cyclosporine A (CyA) in Finland between 1996 and 2011. Methods: Outcome of 62 HSN patients was evaluated by screening urine and blood samples (n = 51) or by collecting clinical parameters from medical charts until last follow-up visit (n = 11). Sixty (97%) patients had nephrotic-range proteinuria and/or ISKDC grade ≥ III before initial treatment. Patients were initially treated with either MP pulses (n = 42) followed by oral prednisone or with CyA (n = 20). Fifty-nine (95%) patients received angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers. Results: Mean follow-up time was 10.8 years (range 3.2–21.2 years). One patient developed end-stage renal disease and another had decreased renal function (eGFR < 60 mL/min/1.73m2), both initially treated with MP (3%). Six patients (5 MP, 1 CyA) had eGFR between 60 and 89 mL/min/1.73m2 (10%). Eighteen patients (13 MP, 5 CyA) had proteinuria and/or hematuria (29%) and four of them had proteinuria > 0.5 g/day at end of follow-up. Sixteen (38%) MP-treated and two (10%) CyA-treated patients needed additional immunosuppressive treatment (RR 3.81, 95% CI 1.16–14.3, p = 0.035). Late initiation of treatment was associated with an increased risk for persistent proteinuria. Conclusions: Long-term outcome was relatively good in both treatment groups. However, since urinary abnormalities may persist or develop, long-term follow-up of HSN patients is mandatory. Early initiation of treatment had a favorable effect on proteinuria. [ABSTRACT FROM AUTHOR] |
| قاعدة البيانات: |
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