ABSTRACT

A 46-year old man presented with Henoch-Schönlein Purpura (HSP) which associated the renal impairment, nephrotic syndrome and hematuria with preceding upper respiratory tract infection. Since renal biopsy specimens showed membranoproliferative glomerulonephritis with crescent formation, we treated our patient with pulsed methylprednisolone (I gr 1 day, for consecutive 3 days) fallowed by deflazocort (I mg 1 kg 1 day, for 3 months), azathioprine (2 mg/kg/day, 15 days) followed by cyclophosphamide (2 mg 1 kg 1 day, 15 days), dipyridamole (225 mg/day), essential aminoacids (12 gr/day) and plasma exchange ( 4000 ml 1 day, three day s per week for 6 weeks). During follow-up period of five months, creatinine elearance level of the patient elevated gradually but nephroticrange proteinuria and microscobic hematuria persisted. At presentation unfavourable prognostic indicators were nephrotic syndrome, acute renal impairment and the presence of glomerular crescents in Henoch-Schölein Nephritis (HSN). The detection of glomerular crescents in HSP syndrome justified the initiation of aggressive therapy. On the other hand, adult HSN is a potentially catastrophic disease, and requires careful assesment at presentation. We believe that plasma exchange associated with immunosuppressive treatment appears to be effective in eresentic HSN. However, further studies are needed.

Keywords: Henoch Schönlein Nephritis, plasmapheresis, crescentic glomerulonephritis