Therapeutic Effects And Mechanism Of Hemoperfusion On Children With Server Henoch-Sch(?)nlein Purpura Nephritis

Henoch-Schonlein purpura nephritis (HSPN) is the one of the most common secondary kidney diseases in childhood, which is secondary to the primary nephrotic syndrome and acute glomerulonephritis when regarding to the incidence. HSPN is also one of the major causes of chronic renal failure in children. Those manifesting themselves clinically as acute nephritic syndrome or nephrotic syndrome are considered severe HSPN cases. The pathological features of severe HSPN include moderate or severe mesangial proliferation, necrosis of vascular loop and varying degrees of crescent formation in glomerili. The exact pathogenesis has not well known yet so far, while the role of small vessel vasculitis has been confirmed.Traditional therapeutic strategies for HSPN, such as cytotoxic drugs combined with glococortitoid, thrombolytic therapy, antiretroviral therapy, plasma exchange and intravenous immunoglobulin, et al, could increase remission rate and improve the prognosis, but meanwhile resulted in side effects. And some HSPN cases could not obtain a long term remission even all kind of traditional treatments have been used. Researchers found that some cytokines including vascular endothelial growth factors, platelet-derived growth factor, NO, NO synthase, et al, could be responsible for all those cases. All these cytokines could caused injuries to the kidney if not be eliminated in time, consequently affected the prognosis of patients. Hemoperfusion, a new technology developed in recent years, has been applied for treating some diseases in which some traditional treatments could not do a good job. Hemoperfusion is the process in which some endogenous causative agents are'removed from the blood by antigen-antibody binding or carrier-ligandin binding. However, that whether hemoperfusion could remove immune-related factors such as TNF-a, IL-2, IL-6, IL-12, et al, and upregulate VEGF, effectively, thus decrease the damage was rarely reported. So the understanding on the cytokines which were odsorbed during the hemoperfusion hold great importance to explore the pathogenesis of HSPN and the mechanism of the hemoperfusion.Objective: To explore the effects of hemoperfusion on the severe HSPN and the mechanism.Methods:20 children with severe HSPN were chosen as the subjects in the research. All the cases were from the Second Xiangya Hospital, Central South University and were diagnosized as severe HSPN according to the criteria established by the Chinese Medical Science Society Nephrology Group.20 patients were divided randomly into two groups. Cases as control received traditional treatments, methyprednisolone plus mycophenolate mofetil and ACEI. Cases in the treatment group received hemoperfusion besides the traditional treatments.10 healthy children without allergy history, HBV infection and other disease from Hunan Province were chosen as blank control. There were not difference in age and sex among the 3 groups. Blood samples were collected at the same time point (each adsorption before and after treatment) for the detection of VEGF, TNF-a, IL-2, IL-6, IL-12 concentration by ELISA assay.Results(1)Hematuria in all the children from control and the treatment groupThe difference of RBC in uria between the control and treatment group did not hold great significance with P>0.05. RBC in urea decreased significantly after the first hemoperfusion both in control and treatment group, and more obvious in treatment group with P＜0.01. Compared with that in children before the second hemoperfusion RBC in urea from the children in control and treatment group decreased significantly after the second hemoperfusion, and more obvious in treatment group with P<0.01. Compared with that before the third hemoperfusion, the RBC in urea after the third hemoperfusion decreased obviously in children from the control and treatment group, and more obvious in treatment group with P＜0.01.(2) VEGF changes in all the cases before and after the treatmentsCompared with that in children from blank control, VEGF concentration in children from the control and treatment group decreased obviously, with P＜0.01, wihle without difference between the control and the treatment group, with P>0.05. the VEGF concentration increased significantly after the first hemoperfusion both in control and treatment group, and more obvious in treatment group with P＜0.01. Compared with that in children before the second hemoperfusion, the VEGF concentration from the children in control and treatment group increased significantly after the second hemoperfusion, and more obvious in treatment group with P＜0.01. Compared with that before the third hemoperfusion, the VEGF concentration after the third hemoperfusion increased obviously in children from the control and treatment group, and more obvious in treatment group with P<0.01.(3) TNF-αchanges in all the cases before and after the treatmentsCompared with that in children from blank control, TNF-αconcentration in children from the control and treatment group increased obviously, with P＜0.01, wihle without difference between the control and the treatment group, with P＞0.05. the TNF-αconcentration decreased significantly after the first hemoperfusion both in control and treatment group, and more obvious in treatment group with P＜0.01. Compared with that in children before the second hemoperfusion, the TNF-a concentration from the children in control and treatment group decreased significantly after the second hemoperfusion, and more obvious in treatment group with P<0.01. Compared with that before the third hemoperfusion, the TNF-a concentration after the third hemoperfusion decreased obviously in children from the control and treatment group, and more obvious in treatment group with P＜0.01.(4) IL-2 changes in all the cases before and after the treatmentsCompared with that in children from blank control, IL-2 concentration in children from the control and treatment group decreased obviously, with P＜0.01, wihle without difference between the control and the treatment group, with P>0.05. Compared with that in children from control and that in the treatment group before the hemoperfusion, the IL-2 concentration in children from the treatment group increased after the first hemoperfusion, with P<0.01 and more obviously in treatment group. Compared with that in children before the second hemoperfusion, the IL-2 concentration from the children in control and treatment group increased significantly after the second hemoperfusion, and more obvious in treatment group with P＜0.01. Compared with that in children from the treatment group before the third hemoperfusion, IL-2 level increased significantly after hemoperfusion, and more obviously in treatment group with P＜0.01.(5) IL-6 changes in all the cases before and after the treatmentsCompared with that in children from blank control, IL-6 concentration in children from the control and treatment group increased obviously, with P<0.01, wihle without difference between the control and the treatment group, with P＞>0.05. Compared with that in children from control and that in the treatment group before the hemoperfusion, the IL-6 concentration in children from the treatment group decreased after the first hemoperfusion, with P<0.01 and more significantly in the treatment group P<0.01. Compared with that in children from control and the treatment group before the second hemoperfusion, IL-6 level decreased significantly after hemoperfusion, and more significantly in the treatment group with P＜0.01. Compared with that in children from control and the treatment group before the third hemoperfusion, IL-6 level decreased significantly after hemoperfusion, and more significantly in the treatment group with P<0.01.(6) IL-12 changes in all the cases before and after the treatmentsCompared with that in children from blank control, IL-12 concentration in children from the control and treatment group decreased obviously, with P＜0.01, wihle without difference between the control and the treatment group, with P>0.05. Compared with that in children from control and that in the treatment group before the first hemoperfusion, the IL-12 concentration in children from the treatment group increased after the first hemoperfusion, and more significantly in the treatment group with P＜0.01. Compared with that in children from control and that in the treatment group before the second hemoperfusion, IL-12 increased significantly after the second and more obviously in treatment group, with P<0.01. Compared with that in children from the control and treatment group before the third hemoperfusion, IL-12 level increased significantly after hemoperfusion, and more obviously in treatment with P＜0.01.Conclusion:VEGF, TNF-α, IL-2, IL-6, IL-12 took part in the development of HSPN. Perfusion was a new technology for the treatment of HSPN, with more specificity, better efficacy and less side effects.