Efficacy of methylprednisolone and urokinase pulse therapy for severe Henoch-Schonlein nephritis

Objective. To evaluate the efficacy of methylprednisolone and urokinase pulse therapy (MUPT) for severe Henoch-Schonlein nephritis, we examined the clinical manifestation and prognosis of patients with MUPT on long-term observation. Methods. We enrolled 56 patients with Henochschonlein nephritis who had been diagnosed with at least type IIIb from 1980 to 1998 on long-term observation and had been treated with MUPT. The clinical features, laboratory data, and pathologic findings between pre-MUPT and post-MUPT, and the prognosis of these patients on long-term observation were retrospectively investigated. Results. The mean urinary protein excretion after 6 months of treatment had decreased significantly compared with pre-MUPT. Hypercoagulant state in after the completion of urokinase pulse therapy improved compared with pre-MUPT. First renal biopsies were performed in all patients and second biopsies were performed in 27 patients. The activity index decreased significantly from 4.1 +/- 1.9 at first biopsy to 2.5 +/- 1.7 at second biopsy, while the chronicity index did not differ between first and second biopsy. None had renal insufficiency and renal survival rate was 100% for the decade. Conclusions. Although uncontrolled, our study suggested that MUPT is effective for those patients with the risk of progression of their nephropathy, especially if started early during the course of the disease before the crescents become fibrous.