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Schönlein-Henoch disease: treatment
Last reviewed: 23.11.2021
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The treatment of Shenllein-Henoch disease depends on the prevailing clinical symptoms of Shenlen-Henoch disease.
- If there is an infection, antibiotic therapy is indicated.
- Skin and joint syndromes without visceral manifestations are an indication for the administration of NSAIDs.
- In severe skin and GI traction, glucocorticoids are prescribed. According to some authors, the early administration of prednisolone in a short course prevents the development of glomerulonephritis with purple Shoinlein-Genocha.
Approaches to the treatment of glomerulonephritis in the case of Shenllein-Henoch disease are contradictory. The tactics of treating glomerulonephritis with Schönlein-Henoch purpura depends 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 kidney function do not need treatment with glucocorticoids. This form of jade, as a rule, is prone to spontaneous remissions or recovery.
- Patients with nephrotic syndrome or fast-progressive glomerulonephritis are indicated for the appointment of immunosuppressive drugs, but so far there are no controlled clinical studies comparing the effectiveness of different regimens of therapy.
- In the presence of a nephrotic syndrome with normal kidney function in children, it is recommended to start treatment with pulse therapy with methylprednisolone 1 g intravenously for 3 days, followed by the appointment of prednisolone by mouth at a dose of 1 mg / kg body weight per day for 1 month, after which an alternating taking medication at a dose of 1 mg / kg of body weight per day every other day for 2 months. Further treatment by alternating scheme continues for another 2 weeks, reducing the dose to 0.5 mg / kg of body weight every other day. This method of treatment makes it possible to achieve a 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 is recommended, including in the regime of pulse therapy. In addition, these patients are also offered to use intravenous immunoglobulin infusions. It is also possible to combine immunosuppressive therapy with plasmapheresis, anticoagulants (heparin, warfarin) and antiaggregants (dipyridamole). Recently, the efficacy of urokinase fibrinolytic therapy in patients with nephritis with Schönlein-Genoch purpura has been reported, which has been shown to not only affect the intrabuccal clotting process, but also to promote proteolysis of the extracellular matrix.
When developing in patients with nephritis terminal chronic renal failure, the basic treatment of Shenllein-Henoch disease is hemodialysis and kidney transplantation. Recurrence of glomerulonephritis in the transplant is rare, but in almost half of the patients who underwent biopsy of the transplant, mesangial deposits of IgA were found in the absence of clinical signs of glomerulonephritis.
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