| Objective1. To analyze the clinical, pathological data and outcomes of the adult patients with Henoch-Schonlein purpura nephritis (HSPN).2. To analyze the efficacy of immune suppressants in Henoch-Schonlein purpura (HSP) with moderate proteinuria, emphasizing on mycophenolate mofetil (MMF).Methods1. The data of205HSPN patients who were diagnosed in Kidney Disease center of the First Affiliated Hospital of Zhejiang University between Jan2004and May2013were collected and analyzed in different groups.2. Sixty-three HSPN patients with moderate proteinuria (1.0-3.5g/24hr) after at least3-month therapy of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) were enrolled into3groups: MMF group (n=21) received MMF1.0-1.5g/d combined with prednisone (0.4-0.5mg/kg/d), corticosteroid (CS) group (n=27) received full-dose prednisone (0.8-1.0mg/kg/d) and control group (n=15) continued to receive ACEI or ARB till tolerated dose. Results1. The average age was (33±16) years old. All patients had purpura,25%patients had abdominal symptoms and arthritis was reported in18.5%patients. All patients reported hematuria;32.7%patients were with urine protein less than1g/24h and21.9%patients had urine protein greater than3.5g/24h;73.7%patients had normal level of glomerular filtration rate (eGFR, calculated by simplified MDRD equation);14.1%patients had mild renal insufficiency [eGFR60～90ml·min-1-(1.73m2)-1]and12.2%patients were with eGFR less than60ml-min-1·（1.73m2)"1. The type II renal pathological changes were reported in20.5%patients,71.7%patients were with type Ⅲ,7.3%patients were with type Ⅳ and only one patient had type V pathological changes. The patients younger than18years had more abdominal involvement; the patients older than50years had higher serum levels of ESR, C reactive protein, IgA and more proportion of glomerular sclerosis, but lower eGFR level. Thirty-eight patients (18.5%) were lost follow up. The median follow up time of the other167patients was15months. The complete remission was reported in124patients (60.5%) and partial remission were reported in15patients (7.3%);22patients were unrelieved and6patients exhibited end stage renal disease (ESRD). The COX regression analysis revealed that old age was the independent risk factor of no relief and ESRD (P=0.011, OR=2.434).2. The follow up time was33±17months (6-78months). The baseline proteinuria was higher in MMF group (2.2±0.9g/l) than that in control group (1.4±0.7g/l, p=0.007). No significant difference existed on serum albumin, glomerular filtration rate or severity of renal pathology among groups. During follow up, the proteinuria decreased significantly in MMF group and CS group, but did not decrease significantly in control group. The remission rates in MMF group, CS group and control group were respectively80.9%,74.1%,46.7%at6months and76.2%,70.4%,40%at the end of follow up. The overall incidence of adverse effects was 57.1%in MMF group,70.4%in CS group, and20%in control group. The incidence of metabolic disorders such as hypertriglyceridemia and hyperglycemia was highest in CS group..ConclusionsThe old HSPN patients had higher disease activity, more obvious decline in renal function and higher risk of treatment failure; MMF with prednisone was effective for adult HSP patients with moderate proteinuria and had fewer side effects than full-dose prednisone. |
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