Management Options for Henoch-Schönlein Nephritis: Evidence-based Approach

WKY CHAN, SY CHAN, W CHIU, KW FONG, KW LEE, NKC TSE, SN WONG, PS YEUNG

Henoch-Schönlein purpura (HSP) is a common vasculitic disease in children. Renal involvement in HSP is not uncommon and accounts for major morbidity. There are a lot of controversies in the management of patients with Henoch-Schonlein nephritis. After reviewing the literatures, our group conclude that (a) The presenting renal histology, which reveals the severity of kidney damage, is by far the most useful, although not entirely reliable prognosticator. (b) Patients with minor urinary abnormalities at presentation do not need any form of intervention, however follow up for subsequent renal impairment may be necessary. (c) Patients with moderate renal involvement may warrant treatment and (d) renal biopsy is indicated in order to guide the treatment and give a better prediction of outcome. (e) Patients with rapidly progressive glomerulonephritis deserve aggressive intervention so as to halt the progression of renal damage and subsequent renal failure. Corticosteroid in combination with immunosuppressive agents is the commonly used treatment option and plasmapheresis could be an adjuvant therapy. (HK J Paediatr (new series) 2004;9:13-23)

Key words : Glomerulonephritis; Henoch-Schonlein nephritis; Henoch-Schonlein purpura

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