Efficacy and safety of methylprednisolone pulse for Henoch-Schoenlein purpura nephritis with few crescentic lesions

Objective  To explore the clinical efficacy and safety of methylprednisolone （MP） pulse in children with Henoch-Schoenlein purpura nephritis （HSPN） with few crescentic lesions to provide therapeutic rationales.

Methods  A retrospective review was conducted for 142 children hospitalized from January 2015 to June 2021. HSPN was confirmed by renal biopsy and had a renal crescent proportion of 10%-20%. Inter-group differences in clinical efficacy, adverse drug reactions and prognosis were recorded.

Results  24 h hourly urine protein quantification （24 hUTP） and urine red blood cell count of children in 2 groups post-treatment were significantly lower than pre-treatment （P＜0.05）. Serum albumin （Alb） rose markedly after 3/6-month treatment as compared with pre-treatment （P＜0.05）. Serum creatinine （Scr） stabilized and inter-group difference was not statistically significant （P＞0.05）. 24 hUTP in MP group at Month 6 was lower than the previous timepoint （P＜0.05）. 24 hUTP at 6 months of treatment was lower than the previous timepoint in MP group （P＜0.05） and 24 hUTP at 6 months of treatment in non-MP group was not statistically significant compared with the previous timepoint （P＞0.05）; Inter-group differences in complete remission rate and total effective rate at different timepoints were not statistically significant （P＞0.05）; Inter-group differences in prognostic grade were not statistically significant （P＞0.05） and time of abnormal urinalysis was shorter in MP group than that in non-MP group （P＞0.05）. Time of abnormal urinalysis was shorter in MP group than that in non-MP group （P＜0.05）, duration of glucocorticoid dosing was shorter in MP group than that in non-MP group（P＜0.05） and recurrence rate was lower in MP group than that in non-MP group; the incidence of adverse reactions was higher in MP group than that in non-MP group （P＜0.05）.

Conclusions  In HSPN children with 10%-20% crescentic lesions, short-term efficacy of MP shock therapy is comparable to that of oral glucocorticoids. However, the effect of reducing urinary protein is more stable and long-lasting and it can effectively shorten the duration of abnormal urinalysis and the course of glucocorticoid dosing and reduce the recurrence rate. However, MP shock therapy is more prone to adverse effects.