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NDT Plus Advance Access originally published online on July 25, 2008
NDT Plus 2008 1(5):303-306; doi:10.1093/ndtplus/sfn106
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Successful treatment of Henoch-Schonlein purpura nephritis with plasma exchange in an adult male

Kunal Chaudhary1,2, Ji-Young Shin2, Georges Saab1,2 and Alan M. Luger2

1 Harry S Truman VA Hospital
2 University of Missouri Health Center, Columbia, USA

Correspondence: Correspondence and offprint requests to: Kunal Chaudhary, Harry S Truman VA Hospital, 800 Hospital Drive, Columbia, MO 65201, USA. Tel: +1-573-882-8556; Fax: +1-573-814-6314; E-mail: chaudharyk{at}health.missouri.edu


  Abstract

Henoch-Schonlein purpura (HSP) frequently occurs in children under 15 years of age but is quite rare in adults. Most children who develop HSP nephritis completely recover from the illness, whereas up to 40% of adults have persistent hematuria and 10% develop chronic renal failure. Plasma exchange alone has been shown to be beneficial in children who have HSP nephritis. Adults have been treated using immunosuppressive drugs such as cyclophosphamide but effects are not certain. Here, we present a case of a 59-year-old white male who developed HSP nephritis while undergoing treatment with steroids. The patient developed acute renal failure with proteinuria and hematuria ~2 weeks after being initially diagnosed with HSP by skin biopsy. Renal biopsy showed proliferative, exudative glomerulonephritis involving all 20 glomeruli; some with early crescent formation. Immunofluorescence staining showed 3+ IgA deposits in mesangium suggesting HSP-induced GN. The patient's serum creatinine rose to 2.5 mg/dl with ~5 g of proteinuria by dipstick. Steroids were continued and the patient received plasma exchange treatments. Due to a very low leukocyte count, immunosuppressive agents were not given. Subsequently, renal function improved and the creatinine level came down to 1.3 mg/dl and proteinuria to <1 g/24 h. Since then, 1 year after this event, his serum creatinine has continued to stay at 1.2 mg/dl and he has trace proteinuria while taking a low-dose ACE inhibitor. This case illustrates the usefulness of plasma exchange in adult onset HSP nephritis, even without concomitant use of cytotoxic agents.

Key Words: Henoch-Schonlein purpura • nephritis • plasmapheresis

Received for publication May 15, 2008. Accepted for publication July 2, 2008.


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