To treat or not to treat What patient Major prognostic factors Therapeutic use of histological findings Interpretation of non prospective r in addition to omized studies on HSPN Effective treatments as long as HSPN (RCT) Cochrane Renal group 2008

To treat or not to treat What patient  Major prognostic factors Therapeutic use of histological findings Interpretation of non prospective r in addition to omized studies on HSPN Effective treatments as long as HSPN (RCT) Cochrane Renal group 2008 www.phwiki.com

To treat or not to treat What patient Major prognostic factors Therapeutic use of histological findings Interpretation of non prospective r in addition to omized studies on HSPN Effective treatments as long as HSPN (RCT) Cochrane Renal group 2008

Malone, Rich, News Director has reference to this Academic Journal, PHwiki organized this Journal Henoch-Schönlein purpura:can we prevent nephritis in addition to progression A Oner in addition to J-C Davin: experts Comments :R Bogdanovic ESPN Lyon 2008 Relation between biological IgA abnormalities in addition to mesangial IgA deposits in isolated hematuria in childhood Davin, Foidart, Mahieu Clin Nephrol 1987. In HSP, predominant IgA deposits in mesangium in addition to along capillary walls as well as in other organs. High frequence of IgA abnormalities in HSP vs C in addition to NS No more terminal galactosyl residue No IgA1 hepatic clearance Normal control HSP in addition to IgAN Terminal galactosyl residues binding to hepatocytes

Hendrix College US www.phwiki.com

This Particular University is Related to this Particular Journal

Effecter mechanisms of IgA deposits in HSPN EC activation by IgACC, IL-8:Inflammation vWF:Thrombocyte aggregation MC activation by IgACC EC Podocyte MC Crescents as long as mation Fibrosis To treat or not to treat What patient dilemma: all kind of initial clinical symptoms can resolve spontaneously or lead to CRF Risk of CRF in 78 patients with HSPN followed during 23.4 y (mean) Goldstein et al, Lancet 1992 Patients to treat

Long term outcome of HSPN (Goldstein et al, Lancet 1992) ANY INITIAL RENAL PRESENTATION OR EVEN APPARENT COMPLETE HEALING CAN LEAD TO CHRONIC RENAL INSUFFICIENCY Major prognostic factors Initial clinical signs Persisting proteinuria Persisting renal insufficiency Frequent relapsing macroscopic hematuria Histology

Therapeutic use of histological findings > 50% Crescents, high activity index High chronicity index, low activity index Add ACE inhibitors, No immunosuppression, Intensify immunosuppression Interpretation of non prospective r in addition to omized studies on HSPN A/ Spontaneous complete recovery Bariety et al (1964), Vernier et al (1975) : the natural history of this disease favors rapid recovery even following the appearance of the nephrotic syndrome, renal insufficiency, or gross haematuria during the first few months of illness B/ Late deterioration by hyperfiltration after apparent complete recovery. C/ Unpredictable evolution according to clinical symptoms D/ No placebo group possible in some categories of patients because of high CRF risk Effective treatments as long as HSPN (RCT) Cochrane Renal group 2008 Anti-inflammatory Steroids (no) Plasma exchange (no) Immunosuppressive Steroids (no) CCP,MMF,CsA (no) Rituximab (no) Plasma exchange (no) Anti-coagulation Anti-platelets aggregation (no) Heparin (no) Anti-MC proliferation ACE inhibitors (no but well as long as IgAN) Anti-hyperfiltration ACE inhibitors (no but well as long as IgAN)

Methylprednisolone pulse therapy in the treatment of severe as long as ms of Schönlein Henoch purpura nephritis Niaudet in addition to Habib Ped Nephrol 1997 Historical series (no MPNS) NS Patients Number: 29 ESRF:11 (38%) Latest follow-up: Relation CRI in addition to > 50% crescents MPNS series NS Patients Number:38 ESRF:4 (10%) Latest follow-up: 1-16 y Relation delayed treatment/ CRI Treating severe Henoch-Schönlein in addition to IgA nephritis with plasmapheresis alone Shenoy, Ognjanovic, Coulthard 2007 -14 HSPN, 2 IgAN -Mean GFR at presentation: 56 ml/min/ 1.73m2 -Nephrotic syndrome -Plasmapheresis only -Mean follow up: 4 years MPNS followed by prednison MMF Plasmapheresis 3x / w Biopsy 1 Biopsy 2 Proteinuria Case report Presentation: purpura, microhematuria, proteinuria, NS, joints pain, mild renal insufficiency Biopsy 1: diffuse endocapillary proliferation, 25 % crescents Biopsy 2: diffuse endocapillary proliferation, 25 % crescents

MPNS CPP Pred ACE-I Patient history 6 year old girl Palpable purpura 6 months ago Abdominal pain, arthralgia Proteinuria in addition to hypoalbuminemia Delayed treatment Renal biopsy 25% glomeruli with crescents Mesangial proliferation Mesangial in addition to subentothelial IgA deposits Patient History Proteinuria (g/L) Pl. albumin (g/L) Pl.creatinine (µmol/L Apparent recovery CRF no renal symptoms, no treatment Isolated hematuria, minimal proteinuria No biopsy no treatment, excepted in repeated macroscopic hematuria. In all other cases: renal biopsy a/ < 50% crescents: MPNS followed by prednisone Insufficient response: add immunosuppression, Insufficient response: repeat biopsy: eventually PEs b/ > 50% crescents: ID + immunosuppression Insufficient response, repeat biopsy Add PEs c/ residual proteinuria: ACE inhibitors Apparent recovery Look as long as hyperfiltration in addition to eventually ACE inhibitors What we actually do Henoch Schonlein purpura in children: an epidemiological study among Dutch paediatricians on incidence in addition to diagnostic criteria. Aalberse J, Dolman K, Ramnath G, Peirera R, Davin JC Ann Rheum Dis 2007 General Data 232 patients/y (1-18y)/16 millions Incidence 1-18y: 6.1/100,000 3-6 y: 14.9/100,000 IgA in skin biopsy (53%) how many of them have really HSP

EULAR/PRES Endorsed Consensus Criteria as long as the Classification of Childhood Vasculatides under review by the ACR (Vienna 2005) Ann.Rheum. Dis. Online Dec 2005 Seza Ozen, Nicolino Ruperto Michael Dillon Arvind Bagga Karryl Barron Jean-Claude Davin Tomisaku Kawasaki Carol Lindsay Ross Petty Anne-Marie Prieur Angello Ravelli Patricia Woo At least one of the following 4 should be present: Diffuse abdominal pain Any biopsy showing predominant IgA deposition Arthritis or arthralgia Renal involvement (any hematuria in addition to /or proteinuria) In the presence of Palpable Purpura (m in addition to atory criterion) EULAR/PRES Classification Criteria as long as HSP Message to take home Treat excepted as long as mild symptoms MPNS in addition to not prednisone only Do not delay treatment Repeat biopsy if treatment failure Adapt treatment according to histology in addition to response Follow at long term even when complete recovery International multicenter RCT are needed

Malone, Rich Northern Arizona's Afternoon News - KVNA-AM News Director www.phwiki.com

Malone, Rich News Director

Malone, Rich is from United States and they belong to Northern Arizona’s Afternoon News – KVNA-AM and they are from  Flagstaff, United States got related to this Particular Journal. and Malone, Rich deal with the subjects like International News; Local News; National News; News Programming; Regional News

Journal Ratings by Hendrix College

This Particular Journal got reviewed and rated by Hendrix College and short form of this particular Institution is US and gave this Journal an Excellent Rating.