Prevention and treatment of renal disease in Henoch-Schönlein purpura: a systematic review.
OBJECTIVE
To determine the benefits and harms of therapies used to prevent or treat renal involvement in Henoch-Schönlein purpura.


METHODS
Systematic review of randomised controlled trials.


METHODS
Secondary and tertiary paediatric and paediatric nephrology services.


METHODS
Ten trials involving 1230 children aged less than 18 years.


METHODS
Persistent proteinuria and/or haematuria.


RESULTS
Meta-analyses of four trials showed no significant difference in the risk of persistent kidney disease at 6 months (379 children; relative risk (RR) 0.51, 95% CI 0.24 to 1.11) and 12 months (498 children; RR 1.02, 95% CI 0.40 to 2.62) in children given prednisone for 14-28 days at presentation of Henoch-Schönlein purpura compared with placebo or supportive treatment. In children with severe renal disease, there was no significant difference in the risk of persistent renal disease with cyclophosphamide compared with supportive treatment (one trial; 56 children; RR 1.07, 95% CI 0.65 to 1.78) and with cyclosporin compared with methylprednisolone (one trial; 19 children; RR 0.39; 95% CI 0.14 to 1.06).


CONCLUSIONS
Data from randomised trials for any intervention used to improve renal outcomes in children with Henoch-Schönlein purpura are very sparse except for short-term prednisone, which has not been shown to be effective.
Chartapisak
W
W
Cochrane Renal Group, Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia.
Opastiraku
S
S
Willis
N S
NS
Craig
J C
JC
Hodson
E M
EM
D005938:Glucocorticoids / Q000627:therapeutic use; D006417:Hematuria / Q000209:etiology / Q000628:therapy; D006801:Humans; D011695:IgA Vasculitis / Q000150:complications / Q000188:drug therapy*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007674:Kidney Diseases / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011507:Proteinuria / Q000209:etiology / Q000628:therapy; D016032:Randomized Controlled Trials as Topic / Q000592:standards; D012107:Research Design / Q000592:standards
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D010975:Platelet Aggregation Inhibitors