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American Journal of Kidney Diseases

Addition of Plasma Exchange to Glucocorticosteroids for the Treatment of Severe Henoch-Schönlein Purpura in Adults: A Case Series

Published:February 10, 2012DOI:https://doi.org/10.1053/j.ajkd.2011.12.015

      Background

      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 m2 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.

      Index Words

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