Azathioprine Therapy in Henoch-Schönlein Purpura Nephritis Accompanied by Nephrotic syndrome

Son, Jin-Tae; Kim, Ji-Hong; Kim, Pyung-Kil; Chung, Hyeun-Joo

J Korean Soc Pediatr Nephrol > Volume 2(1); 1998 > Article

J Korean Soc Pediatr Nephrol 1998;2(1): 41-49.

신증후군을 동반한 HSP 신염에서 Azathioprine의 치료 효과

손진태, 김지홍, 김병길, 정현주

¹연세대학교 의과대학 소아과학교실
²연세대학교 의과대학 소아과학교실
³연세대학교 의과대학 소아과학교실
⁴연세대학교 의과대학 병리학교실

Azathioprine Therapy in Henoch-Schönlein Purpura Nephritis Accompanied by Nephrotic syndrome

Jin-Tae Son, Ji-Hong Kim, Pyung-Kil Kim, Hyeun-Joo Chung

¹Departments of Pediatrics, College of Medicine, The Institute of Kidney Disease, Yonsei University
²Departments of Pediatrics, College of Medicine, The Institute of Kidney Disease, Yonsei University
³Departments of Pediatrics, College of Medicine, The Institute of Kidney Disease, Yonsei University
⁴Departments of Pathology, College of Medicine, The Institute of Kidney Disease, Yonsei University

ABSTRACT

Treatment of $Henoch-Sch""{o}nlein$ purpura nephritis(HSPN) accomanied by nephrotic syndrome is still controversal, even though both corticosteroids and immunosuppressants have been used for therapy. Azathioprine(AZA) is a chemical analog of the physiologic purines-adenine, guanine, and hyoxanthine and an antagonist to purine metabolism which may inhibit RNA and DNA synthesis and is mainly used for immunosuppressive agent. We studied the effects of AZA in HSPN accompanied by nephrotic syndrome and evaluating the clinical status and histopathologic changes by sequential biopsies following the treatment. Fifteen patients with nehprotic syndrome either initially or during the course of HSPN confirmed by renal biopsies were treated with AZA(2 mg/kg/day) and prednisolone (0.5-1 mg/kg/day qod) for 8months. Folow up renal biopsy was done after treatment in 11 patients. The clinical status of the patients on admission were C(12 cases) and B(3 cases). Improvement of clinical status were showed in 12 cases, but 3 cases were not improved and 1 case was aggrevated after AZA treatment. Complete remission of proteinuria were in 8 cases(53.3%), partial remission were in 4 cases(26.7%) and persistence of proteinuria and hematuria were in 3 cases(20.0%). The loss of hematuria were in 10 cases(66.7%). Histopathologically and immunopathologically, 4 cases were improved. This study suggests that, although control studies are needed, AZA could be used in the treatment of HSPN accompanied by nephrotic syndrome.

Key words: $Henoch-Sch\""{o}nlein$ purpura nephritis | Nephrotic syndrome | Azathioprine