Multiple combined therapy for severe Henoch-Schonlein nephritis in children

From 1980 through 1992, 14 children with Henoch-Schonlein nephritis (HSN) showing severe glomerular changes (grade IV or V) were given a multiple combined therapy with prednisolone, cyclophosphamide, heparin/ warfarin, and dipyridamole, and were followed for 7.5 +/- 0.9 years. The period between the onset of nephritis and the start of therapy was 0.8 +/- 0.4 years. Ten patients underwent follow-up biopsy after therapy. The percentage of glomeruli having crescents/segmental lesions was significantly reduced after therapy (70% +/- 5% vs. 42% +/- 7%, P <0.01), due mainly to the resolution of crescents (51% +/- 8% vs. 13% +/- 5%, P <0.01). Thus, histological grade was significantly improved (5 grade IV and 5 grade V vs. 7 grade III and 3 grade IV, P <0.01). After an average follow-up period of 7.5 years, 9 patients showed normal urine and renal function, 4 showed minor urinary abnormalities, and 1 heavy proteinuria. No patient developed chronic renal insufficiency. These findings suggest that the multiple combined therapy could be effective for histologically severe HSN, although a prospective controlled study should be performed.