Effects of Cyclophosphamide Pulse Therapy on the Clinical and Histopathological Findings, Particularly Crescent Formation, in a Patient with Adult-onset Steroid-refractory Henoch-Schönlein Purpura Nephritis

Yusuke Tanaka; Yuri Nakashima; Toru Mima; Masaki Ohya; Shuto Yamamoto; Sou Kobayashi; Asuka Masumoto; Koji Masumoto; Takurou Yano; Mari Moribata; Wataru Yoshimoto; Shintaro Yamanaka; Daisuke Koreeda; Yoshiyuki Hanba; Koichi Tatsuta; Toshifumi Sakaguchi; Shigeo Negi; Takashi Shigematsu

doi:10.2169/internalmedicine.54.4330

CASE REPORTS

Effects of Cyclophosphamide Pulse Therapy on the Clinical and Histopathological Findings, Particularly Crescent Formation, in a Patient with Adult-onset Steroid-refractory Henoch-Schönlein Purpura Nephritis

Yusuke Tanaka, Yuri Nakashima, Toru Mima, Masaki Ohya, Shuto Yamamoto, Sou Kobayashi, Asuka Masumoto, Koji Masumoto, Takurou Yano, Mari Moribata, Wataru Yoshimoto, Shintaro Yamanaka, Daisuke Koreeda, Yoshiyuki Hanba, Koichi Tatsuta, Toshifumi Sakaguchi, Shigeo Negi, Takashi Shigematsu

Author information

Yusuke Tanaka
Department of Nephrology and Dialysis, Shingu Municipal Medical Center, Japan
Yuri Nakashima
Division of Nephrology, Department of Internal Medicine, Wakayama Medical University, Japan
Toru Mima
Division of Nephrology, Department of Internal Medicine, Wakayama Medical University, Japan
Masaki Ohya
Division of Nephrology, Department of Internal Medicine, Wakayama Medical University, Japan
Shuto Yamamoto
Department of Nephrology and Dialysis, Shingu Municipal Medical Center, Japan
Sou Kobayashi
Department of Nephrology, Blood Purification Center, Rinku General Medical Center, Japan
Asuka Masumoto
Division of Nephrology, Department of Internal Medicine, Wakayama Medical University, Japan
Koji Masumoto
Department of Nephrology and Dialysis, Social Insurance Kinan Hospital, Japan
Takurou Yano
Department of Nephrology, Blood Purification Center, Rinku General Medical Center, Japan
Mari Moribata
Division of Nephrology, Department of Internal Medicine, Wakayama Medical University, Japan
Wataru Yoshimoto
Naga Hospital, Japan
Shintaro Yamanaka
Division of Nephrology, Department of Internal Medicine, Wakayama Medical University, Japan
Daisuke Koreeda
Division of Nephrology, Department of Internal Medicine, Wakayama Medical University, Japan
Yoshiyuki Hanba
Division of Nephrology, Department of Internal Medicine, Wakayama Medical University, Japan
Koichi Tatsuta
Division of Nephrology, Department of Internal Medicine, Wakayama Medical University, Japan
Toshifumi Sakaguchi
Department of Nephrology, Blood Purification Center, Rinku General Medical Center, Japan
Shigeo Negi
Division of Nephrology, Department of Internal Medicine, Wakayama Medical University, Japan
Takashi Shigematsu
Division of Nephrology, Department of Internal Medicine, Wakayama Medical University, Japan

Keywords: histopathology, Henoch-Schönlein purpura, glomerular nephritis, renal biopsy

JOURNAL OPEN ACCESS

2015 Volume 54 Issue 17 Pages 2207-2211

DOI https://doi.org/10.2169/internalmedicine.54.4330

Details

Abstract

A 29-year-old woman was diagnosed with Henoch-Schönlein purpura nephritis (HSPN) based on the presence of purpura and histopathological findings showing crescent formation, mesangial proliferation and IgA deposition in the glomerular mesangium. She was treated with high-dose steroids; however, the nephritic syndrome persisted. Therefore, we diagnosed her with steroid-resistant HSPN and decided to add treatment with cyclosphamide pulse therapy. After one year of treatment, the histopathological findings, including crescent formation and IgA deposition, improved, as confirmed on a renal biopsy, and the patient fulfilled the criteria for complete remission. Cyclophosphamide pulse therapy may be considered an effective treatment for intractable HSPN.

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