MULTIPLE COMBINED THERAPY FOR SEVERE HENOCH-SCHONLEIN NEPHRITIS IN CHILDREN

From 1980 through 1992, 14 children with Henoch-Schonlein nephritis (H SN) showing severe glomerular changes (grade IV or V) were given a mul tiple combined therapy with prednisolone, cyclophosphamide, heparin/ w arfarin, and dipyridamole, and were followed for 7.5 +/- 0.9 years. Th e period between the onset of nephritis and the start of therapy was 0 .8 +/- 0.4 years. Ten patients underwent follow-up biopsy after therap y. The percentage of glomeruli having crescents/segmental lesions was significantly reduced after therapy (70% +/- 5% vs. 42% +/- 7%, P <0.0 1), due mainly to the resolution of crescents (51% +/- 8% vs. 13% +/- 5%, P <0.01). Thus, histological grade was significantly improved (5 g rade 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 uri ne and renal function, 4 showed minor urinary abnormalities, and 1 hea vy proteinuria. No patient developed chronic renal insufficiency. Thes e findings suggest that the multiple combined therapy could be effecti ve for histologically severe HSN, although a prospective controlled st udy should be performed.