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Addition of plasma exchange to glucocorticosteroids for the treatment of severe Henoch-Schönlein purpura in adults: a case series.

AbstractBACKGROUND:
Adult Henoch-Schönlein purpura (HSP) has been associated with poor outcome and end-stage renal disease in >20% of cases. Although the benefit of adding another immunosuppressant to steroids in severe adult HSP has not been shown, the benefit of plasma exchange (PE) therapy has been poorly evaluated.
STUDY DESIGN:
Case series.
SETTING & PARTICIPANTS:
11 consecutive patients with severe and newly diagnosed HSP since 1988 who were treated with steroids and PE.
OUTCOME & MEASUREMENT:
Patients' characteristics and outcome were analyzed. Birmingham Vasculitis Activity Score (BVAS), estimated glomerular filtration rate (eGFR), and proteinuria were measured at baseline, at the end of PE treatment, at months 6 and 12, and at the last visit. Side effects of corticoid treatment and PE were recorded.
RESULTS:
11 patients were identified in 1988-2010. Patients received intravenous corticoid pulses in 64% of cases, followed by oral prednisone for a median of 6.6 months. They received a median of 12 PE sessions. BVAS, eGFR, and proteinuria improved significantly between baseline and the last PE at a median of 2 months. PE sessions were well tolerated, except in one patient who developed central catheter-associated septicemia. One patient required dialysis therapy 15 days after HSP diagnosis and did not recover kidney function. At the last medical evaluation at a mean follow-up of 6 years, median eGFR and proteinuria were 83 ± 22 mL/min/1.73 m(2) and protein excretion of 140 ± 10 mg/d, respectively. 3 women had pregnancy without complications.
LIMITATIONS:
This case series did not have a control group.
CONCLUSIONS:
The combination of PE and corticoid therapy in severe forms of HSP was associated with fast improvement and good long-term outcome.
AuthorsJean-François Augusto, Johnny Sayegh, Laurence Delapierre, Anne Croue, Fréderic Tollis, Maud Cousin, Jean-François Subra
JournalAmerican journal of kidney diseases : the official journal of the National Kidney Foundation (Am J Kidney Dis) Vol. 59 Issue 5 Pg. 663-9 (May 2012) ISSN: 1523-6838 [Electronic] United States
PMID22300649 (Publication Type: Case Reports, Clinical Trial, Journal Article)
CopyrightCopyright © 2012 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
Chemical References
  • Glucocorticoids
Topics
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Combined Modality Therapy
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate (physiology)
  • Glucocorticoids (therapeutic use)
  • Humans
  • IgA Vasculitis (physiopathology, therapy)
  • Male
  • Middle Aged
  • Plasma Exchange
  • Proteinuria (physiopathology)
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult

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