Full Text:   <1285>

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CLC number: R692.3

On-line Access: 2015-09-05

Received: 2014-12-07

Revision Accepted: 2015-03-05

Crosschecked: 2015-08-10

Cited: 3

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Citations:  Bibtex RefMan EndNote GB/T7714


Jiang-hua CHEN


Fei Han


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Journal of Zhejiang University SCIENCE B 2015 Vol.16 No.9 P.772-779


Mycophenolate mofetil plus prednisone for inducing remission of Henoch-Schönlein purpura nephritis: a retrospective study

Author(s):  Fei Han, Liang-liang Chen, Ping-ping Ren, Jing-yun Le, Pei-jing Choong, Hong-ju Wang, Ying Xu, Jiang-hua Chen

Affiliation(s):  Kidney Disease Center, the First Affiliated Hospital, School of Medicine, Zhejiang University / Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province / the Third Grade Laboratory under the National State, Administration of Traditional Chinese Medicine, Hangzhou 310003, China

Corresponding email(s):   chenjianghua@zju.edu.cn

Key Words:  Henoch-Schö, nlein purpura, Nephritis, Mycophenolate mofetil, Remission

Fei Han, Liang-liang Chen, Ping-ping Ren, Jing-yun Le, Pei-jing Choong, Hong-ju Wang, Ying Xu, Jiang-hua Chen. Mycophenolate mofetil plus prednisone for inducing remission of Henoch-Schönlein purpura nephritis: a retrospective study[J]. Journal of Zhejiang University Science B, 2015, 16(9): 772-779.

@article{title="Mycophenolate mofetil plus prednisone for inducing remission of Henoch-Schönlein purpura nephritis: a retrospective study",
author="Fei Han, Liang-liang Chen, Ping-ping Ren, Jing-yun Le, Pei-jing Choong, Hong-ju Wang, Ying Xu, Jiang-hua Chen",
journal="Journal of Zhejiang University Science B",
publisher="Zhejiang University Press & Springer",

%0 Journal Article
%T Mycophenolate mofetil plus prednisone for inducing remission of Henoch-Schönlein purpura nephritis: a retrospective study
%A Fei Han
%A Liang-liang Chen
%A Ping-ping Ren
%A Jing-yun Le
%A Pei-jing Choong
%A Hong-ju Wang
%A Ying Xu
%A Jiang-hua Chen
%J Journal of Zhejiang University SCIENCE B
%V 16
%N 9
%P 772-779
%@ 1673-1581
%D 2015
%I Zhejiang University Press & Springer
%DOI 10.1631/jzus.B1400335

T1 - Mycophenolate mofetil plus prednisone for inducing remission of Henoch-Schönlein purpura nephritis: a retrospective study
A1 - Fei Han
A1 - Liang-liang Chen
A1 - Ping-ping Ren
A1 - Jing-yun Le
A1 - Pei-jing Choong
A1 - Hong-ju Wang
A1 - Ying Xu
A1 - Jiang-hua Chen
J0 - Journal of Zhejiang University Science B
VL - 16
IS - 9
SP - 772
EP - 779
%@ 1673-1581
Y1 - 2015
PB - Zhejiang University Press & Springer
ER -
DOI - 10.1631/jzus.B1400335

Objective: The treatment of henoch-Schö;nlein purpura (HSP) with moderate proteinuria remains controversial. We retrospectively analyzed the efficacy of immune suppressants, with a particular emphasis on mycophenolate mofetil (MMF). Methods: Ninety-five HSP patients with moderate proteinuria (1.0–3.5 g/24 h) after at least three months of therapy with angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) were divided into three groups: an MMF group (n=33) that received MMF 1.0–1.5 g/d combined with prednisone (0.4–0.5 mg/(kg·d)), a corticosteroid (CS) group (n=31) that received full-dose prednisone (0.8–1.0 mg/(kg·d)), and a control group (n=31). Patients in the MMF and CS groups continued to take ACEI or ARB at the original dose. The patients in the control group continued to take ACEI or ARB but the dose was increased by (1.73±0.58)-fold. The patients were followed up for 6–78 months (median 28 months). Results: The baseline proteinuria was higher in the MMF group ((2.1±0.9) g/24 h) than in the control group ((1.6±0.8) g/24 h) (P=0.039). The proteinuria decreased significantly in all groups during follow-up, but only in the MMF group did it decrease significantly after the first month. At the end of follow-up, the proteinuria was (0.4±0.7) g/24 h in the MMF group and (0.4±0.4) g/24 h in the CS group, significantly lower than that in the control group ((0.9±1.1) g/24 h). The remission rates in the MMF group, CS group, and control group were respectively 72.7%, 71.0%, and 48.4% at six months and 72.7%, 64.5%, and 45.2% at the end of follow-up. The overall number of reported adverse events was 17 in the MMF group, 30 in the CS group, and 6 in the control group (P<0.001). Conclusions: MMF with low-dose prednisone may be as effective as full-dose prednisone and tend to have fewer adverse events. Therefore, it is probably superior to conservative treatments of adult HSP patients with moderate proteinuria.


方法:回顾性分析2007年1月至2013年6月间在浙江大学附属第一医院肾脏病中心接受肾穿刺活检,且经过3个月以上血管紧张素转换酶抑制剂(ACEI)/血管紧张素受体拮抗剂(ARB)治疗后蛋白尿为1.0~3.5 g/24 h的过敏性紫癜性肾炎患者95例。根据治疗方案分为3组,霉酚酸酯组(33例)在原剂量ACEI/ARB的基础上加用霉酚酸酯联合低剂量糖皮质激素,糖皮质激素组(31例)在原剂量ACEI/ARB的基础上加用全剂量糖皮质激素,对照组(31例)维持单用ACEI/ARB治疗,但可提高其剂量。患者随访观察6~78月(中位观察时间28月),霉酚酸酯组、糖皮质激素组与对照组的蛋白尿缓解率分别为72.7%、64.5%与45.2%(图1),发生副作用分别为17例、30例与6例,糖皮质激素组高脂血症与高血压发生率较高(表3)。


Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article


[1]Chan, T.M., Li, F.K., Tang, C.S., et al., 2000. Efficacy of mycophenolate mofetil in patients with diffuse proliferative lupus nephritis. Hong Kong-Guangzhou Nephrology Study Group. N. Engl. J. Med., 343(16):1156-1162.

[2]Coppo, R., Mazzucco, G., Cagnoli, L., et al., 1997. Long-term prognosis of Henoch-Schönlein nephritis in adults and children. Italian Group of Renal Immunopathology Collaborative Study on Henoch-Schönlein purpura. Nephrol. Dial. Transplant., 12(11):2277-2283.

[3]Coppo, R., Andrulli, S., Amore, A., et al., 2006. Predictors of outcome in Henoch-Schönlein nephritis in children and adults. Am. J. Kidney Dis., 47(6):993-1003.

[4]Counahan, R., Winterborn, M.H., White, R.H., et al., 1977. Prognosis of Henoch-Schönlein nephritis in children. Br. Med. J., 2(6078):11-14.

[5]Du, Y., Hou, L., Zhao, C., et al., 2012. Treatment of children with Henoch-Schönlein purpura nephritis with mycophenolate mofetil. Pediatr. Nephrol., 27(5):765-771.

[6]Foster, B.J., Bernard, C., Drummond, K.N., et al., 2000. Effective therapy for severe Henoch-Schönlein purpura nephritis with prednisone and azathioprine: a clinical and histopathologic study. J. Pediatr., 136(3):370-375.

[7]Ginzler, E.M., Dooley, M.A., Aranow, C., et al., 2005. Mycophenolate mofetil or intravenous cyclophosphamide for lupus nephritis. N. Engl. J. Med., 353(21):2219-2228.

[8]Han, F., Liu, G., Zhang, X., et al., 2011. Effects of mycophenolate mofetil combined with corticosteroids for induction therapy of microscopic polyangiitis. Am. J. Nephrol., 33(2):185-192.

[9]Hu, W., Liu, C., Xie, H., et al., 2008. Mycophenolate mofetil versus cyclophosphamide for inducing remission of ANCA vasculitis with moderate renal involvement. Nephrol. Dial. Transplant., 23(4):1307-1312.

[10]Huber, A.M., King, J., McLaine, P., et al., 2004. A randomized, placebo-controlled trial of prednisone in early Henoch Schonlein Purpura. BMC Med., 2(1):7.

[11]Kawasaki, Y., Suzuki, J., Suzuki, H., 2004. Efficacy of methylprednisolone and urokinase pulse therapy combined with or without cyclophosphamide in severe Henoch-Schöenlein nephritis: a clinical and histopathological study. Nephrol. Dial. Transplant., 19(4):858-864.

[12]KDIGO (Kidney Disease: Improving Global Outcomes) Glomerulonephritis Work Group, 2012. KDIGO clinical practice guideline for glomerulonephritis. Kidney Int. Suppl., 2(2):139-274.

[13]Kellerman, P.S., 2006. Henoch-Schönlein purpura in adults. Am. J. Kidney Dis., 48(6):1009-1016.

[14]Mollica, F., Li, V.S., Garozzo, R., et al., 1992. Effectiveness of early prednisone treatment in preventing the development of nephropathy in anaphylactoid purpura. Eur. J. Pediatr., 151(2):140-144.

[15]Nikibakhsh, A.A., Mahmoodzadeh, H., Karamyyar, M., et al., 2010. Treatment of complicated Henoch-Schönlein purpura with mycophenolate mofetil: a retrospective case series report. Int. J. Rheumatol., 2010:254316.

[16]Oh, H.J., Ahn, S.V., Yoo, D.E., et al., 2012. Clinical outcomes, when matched at presentation, do not vary between adult-onset Henoch-Schönlein purpura nephritis and IgA nephropathy. Kidney Int., 82(12):1304-1312.

[17]Ozen, S., Ruperto, N., Dillon, M.J., et al., 2006. EULAR/PreS endorsed consensus criteria for the classification of childhood vasculitides. Ann. Rheum. Dis., 65(7):936-941.

[18]Pillebout, E., Thervet, E., Hill, G., et al., 2002. Henoch-Schönlein Purpura in adults: outcome and prognostic factors. J. Am. Soc. Nephrol., 13(5):1271-1278.

[19]Pillebout, E., Alberti, C., Guillevin, L., et al., 2010. Addition of cyclophosphamide to steroids provides no benefit compared with steroids alone in treating adult patients with severe Henoch Schonlein Purpura. Kidney Int., 78(5):495-502.

[20]Ren, P., Han, F., Chen, L., et al., 2012. The combination of mycophenolate mofetil with corticosteroids induces remission of Henoch-Schönlein purpura nephritis. Am. J. Nephrol., 36(3):271-277.

[21]Ronkainen, J., Nuutinen, M., Koskimies, O., 2002. The adult kidney 24 years after childhood Henoch-Schönlein purpura: a retrospective cohort study. Lancet, 360(9334):666-670.

[22]Ronkainen, J., Koskimies, O., Ala-Houhala, M., et al., 2006. Early prednisone therapy in Henoch-Schönlein purpura: a randomized, double-blind, placebo-controlled trial. J. Pediatr., 149(2):241-247.

[23]Saulsbury, F.T., 1993. Corticosteroid therapy does not prevent nephritis in Henoch-Schönlein purpura. Pediatr. Nephrol., 7(1):69-71.

[24]Shenoy, M., Bradbury, M.G., Lewis, M.A., et al., 2007. Outcome of Henoch-Schönlein purpura nephritis treated with long-term immunosuppression. Pediatr. Nephrol., 22(10):1717-1722.

[25]Tang, S.C., Tang, A.W., Wong, S.S., et al., 2010. Long-term study of mycophenolate mofetil treatment in IgA nephropathy. Kidney Int., 77:543-759.

[26]Weiss, P.F., Feinstein, J.A., Luan, X., et al., 2007. Effects of corticosteroid on Henoch-Schönlein purpura: a systematic review. Pediatrics, 120(5):1079-1087.

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