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Schoenlein-Genoch disease - Treatment
Last reviewed: 04.07.2025
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Treatment of Henoch-Schonlein disease depends on the predominant clinical symptoms of Henoch-Schonlein disease.
- If infection is present, antibacterial therapy is indicated.
- Skin and joint syndromes without visceral manifestations are an indication for the use of NSAIDs.
- In case of severe skin and gastrointestinal lesions, glucocorticoids are prescribed. According to some authors, early administration of prednisolone in a short course prevents the development of glomerulonephritis in Schonlein-Henoch purpura.
Approaches to the treatment of glomerulonephritis in Henoch-Schonlein disease are contradictory. The tactics of treating glomerulonephritis in Henoch-Schonlein purpura depend on the age of the patients, the nature of the course and the clinical variant of nephritis.
- Most patients with clinical manifestations of latent glomerulonephritis and normal renal function do not require glucocorticoid treatment. This form of nephritis is usually prone to spontaneous remission or recovery.
- Patients with nephrotic syndrome or rapidly progressive glomerulonephritis are indicated for the administration of immunosuppressive drugs, but to date there are no controlled clinical trials of the comparative effectiveness of different treatment regimens.
- In the presence of nephrotic syndrome with normal renal function in children, it is recommended to begin treatment with pulse therapy with methylprednisolone, 1 g intravenously for 3 days, followed by prednisolone orally at a dose of 1 mg / kg of body weight per day for 1 month, after which alternating drug administration is indicated at a dose of 1 mg / kg of body weight per day every other day for 2 months. Then, treatment according to the alternating scheme is continued for another 2 weeks, reducing the dose to 0.5 mg / kg of body weight every other day. This method of treatment allows achieving stable clinical remission in 80% of children.
- For the treatment of adult patients with nephritis with nephrotic syndrome and/or renal dysfunction, as well as rapidly progressive glomerulonephritis, a combination of glucocorticoids with cyclophosphamide, including pulse therapy, is recommended. In addition, intravenous immunoglobulin infusions are also suggested for these patients. A combination of immunosuppressive therapy with plasmapheresis, anticoagulants (heparin, warfarin), and antiplatelet agents (dipyridamole) is also possible. Recently, the effectiveness of fibrinolytic therapy with urokinase in patients with nephritis in Henoch-Schonlein purpura has been reported; it has been shown to not only affect the process of intraglomerular blood coagulation, but also promote proteolysis of the extracellular matrix.
When patients with nephritis develop terminal chronic renal failure, the main treatment for Henoch-Schonlein disease is hemodialysis and kidney transplantation. Relapse of glomerulonephritis in the transplant is rare, but almost half of the patients who underwent transplant biopsy were found to have mesangial IgA deposits in the absence of clinical signs of glomerulonephritis.
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