Preventive Effect of Tonsillectomy on Recurrence of Henoch-Schönlein Purpura Nephritis after Intravenous Methylprednisolone Pulse Therapy

Preventive Effect of Tonsillectomy on Recurrence of Henoch-Schönlein Purpura Nephritis after Intravenous Methylprednisolone Pulse Therapy

CHISATO UMEDA,^1,2 SHUICHIRO FUJINAGA,¹ AMANE ENDO,³ KOJI SAKURAYA,^1,3 SATOSHI ASANUMA⁴ and DAISHI HIRANO²

¹Division of Nephrology, Saitama Children's Medical Center, Saitama, Saitama, Japan
²Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
³Department of Pediatrics and Adolescent Medicine, Juntendo University School of Medicine, Tokyo, Japan
⁴Division of Otorhinolaryngology, Saitama Children's Medical Center, Saitama, Saitama, Japan

Henoch-Schönlein purpura (HSP) is regarded as a benign and self-limiting vasculitis characterized by purpura, arthritis, and gastrointestinal symptoms; however, about one third of the patients develop HSP nephritis (HSPN), the most serious long-term complication. Since 2013, we have proposed that tonsillectomy in addition to intravenous methylprednisolone pulse therapy (IVMP) be performed in all patients with HSPN, similar to immunoglobulin A nephropathy (IgAN) patients because both diseases are considered to a share common pathogenesis. Herein, we retrospectively reviewed the clinical courses of 71 Japanese children with HSPN (34 boys; median age at diagnosis, 6.7 years; median follow-up period, 5.6 years) who had received initial treatment with IVMP (15-20 mg/kg; on 3 consecutive days/week for 3 weeks) followed by oral prednisolone (initially 1 mg/kg; tapered off within 12 months) and achieved clinical remission (i.e., disappearance of both proteinuria and hematuria). The patients were divided into two groups: 31 patients receiving tonsillectomy after IVMP between 2013 and 2017 (tonsillectomy group) and 40 patients receiving IVMP monotherapy between 2003 and 2012 (IVMP group). For the 2 years after IVMP therapy, the rate of HSPN recurrence (i.e., persistent proteinuria combined with hematuria requiring additional treatments) after clinical remission was significantly lower in the tonsillectomy group than the IVMP group (0% vs. 19%, P < 0.05). Despite the short follow-up period in the tonsillectomy group, this study provides the evidence that tonsillectomy may be beneficial for preventing recurrence of HSPN from clinical remission with IVMP therapy in Japanese children.

Keywords —— Henoch-Schönlein purpura nephritis; immunoglobulin A nephropathy; intravenous methylprednisolone pulse; recurrence; tonsillectomy

===============================

Tohoku J. Exp. Med., 2020, 250, 61-69

Correspondence: Shuichiro Fujinaga, M.D., Ph.D., Division of Nephrology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku, Saitama, Saitama 330-8777, Japan.

e-mail: f_shuich@d2.dion.ne.jp