Effects of hemoperfusion in the treatment of childhood Henoch-Schönlein purpura nephritis.

PURPOSE: Immune mediators play a role in the pathogenesis of Henoch-Schönlein purpura (HSP) nephritis. Since hemoperfusion (HP) is able to eliminate the immune mediators in many diseases, we investigated the effects of HP in the treatment of HSP nephritis.

METHODS

90 children with HSP nephritis were enrolled and followed up for 12 months. They were assigned to the HP group or the control group, respectively. Both groups were treated with corticosteroids and other supportive therapy. Patients in the HP group received HP for 3 consecutive days. The major outcomes included the percentage of patients with HSP nephritis, extrarenal symptoms, and recurrences and changes in serum levels of immune mediators.

RESULTS

The percentage of patients with nephritis in the HP group was less than that in the control group at each visit; the differences for prortions at 1, 3, 6, 12 months were 16.7% (p = 0.133), 31.3% (p = 0.004), 10.8% (p = 0.283), and 20.6% (p = 0.003), respectively. The severity and duration of abdominal and joint pains in the acute phase were significantly improved in the HP group compared to those in the control group. Hemoperfusion also significantly reduced patients' serum levels of immune mediators including IgA, TNF-α, IL-6, and LTB4. However, recurrences between the two groups were not significantly different.

CONCLUSIONS

Hemoperfusion in combination with corticosteroid was more effective than corticosteroid alone in treating HSP nephritis. The effects may be achieved by eliminating immune mediators.