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Case Reports in Nephrology
Volume 2015 (2015), Article ID 269895, 5 pages
Case Report

Long-Term Therapeutic Plasma Exchange to Prevent End-Stage Kidney Disease in Adult Severe Resistant Henoch-Schonlein Purpura Nephritis

1Renal Department, Salford Royal NHS Foundation Trust, Salford, Greater Manchester M6 8HD, UK
2Histopathology Department, Salford NHS Foundation Trust, Salford, Greater Manchester M6 8HD, UK
3John Walls Renal Unit, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK

Received 7 August 2015; Accepted 13 October 2015

Academic Editor: Kouichi Hirayama

Copyright © 2015 Patrick Hamilton et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


A 27-year-old man presented with a palpable purpuric skin rash and joint and abdominal pain in April 2010. He had acute kidney injury and his creatinine quickly deteriorated to 687 μmol/L, with associated nephrotic range proteinuria. Kidney biopsy showed crescentic Henoch-Schonlein nephritis. He was treated with intravenous cyclophosphamide and prednisolone despite which his renal function deteriorated; he required haemodialysis for a short duration and seven sessions of therapeutic plasma exchange (TPE). Renal function improved, but after discharge from hospital he suffered 2 further relapses, each with AKI, in 4 months. Cyclophosphamide was not effective and therefore Rituximab was introduced. He initially had a partial response but his renal function deteriorated despite continued therapy. TPE was the only treatment that prevented rapid renal functional deterioration. A novel long-term treatment strategy involving regular TPE every one to two weeks was initiated. This helped to slow his progression to end-stage kidney disease over a 3-year period and to prolong the need for renal replacement therapy over this time.