Methylprednisolone pulse therapy for severe forms of glomerulonephritis due to Henoch-Schonlein purpura.

From 1980 to 1994, 35 children with severe glomerulonephritis due to Henoch-Schonlein purpura were entered into a prospective study to evaluate the effects of methylprednisolone pulses on the course of nephropathy. Based on earlier studies, patients with nephrotic syndrome and/or 50% or more crescentic glomeruli were considered at risk of progression to end stage renal disease and consequently were treated with three methylprednisolone pulses followed by oral steroid therapy. One to 14 years later, 22 patients had clinically recovered, seven had minimal urinary abnormalities, four had persistent nephropathy, and two had progressed to end stage renal disease. Repeated renal biopsies were obtained in 23 patients. They showed a close correlation between the clinical outcome and the histological lesions observed on the second biopsy. Patients who had clinically recovered showed no evidence of active lesions (mesangial proliferation) and only minimal fibrosis. Methylprednisolone pulse therapy may be effective in patients at risk for end stage renal disease provided it is given early in the course of the disease.