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Prevention and treatment of renal disease in Henoch-Schonlein Purpura: a systematic review
  1. Wattana Chartapisak (wchartap{at}mail.med.cmu.ac.th)
  1. Department of Pediatrics, Faculty of Medicine, Chiang Mai University
    1. Sauwalak Opastirakul
    1. Department of Pediatrics, Faculty of Medicine, Chiang Mai University
      1. Narelle Willis (narellw2{at}chw.edu.au)
      1. Cochrane Renal Group, Centre for Kidney Research, The Children's Hospital at Westmead
        1. Jonathan C Craig (jonc{at}health.usyd.edu.au)
        1. Cochrane Renal Group, Centre for Kidney Research, The Children's Hospital at Westmead
          1. Elisabeth M Hodson (elisah{at}chw.edu.au)
          1. Cochrane Renal Group, Centre for Kidney Research, The Children's Hospital at Westmead

            Abstract

            Objective: To determine the benefits and harms of therapies used to prevent or treat renal involvement in Henoch-Schönlein Purpura.

            Design: Systematic review of randomised controlled trials.

            Setting: Secondary and tertiary paediatric and paediatric nephrology services.

            Subjects: Ten trials involving 1230 children aged less than 18 years.

            Main outcome measures: Persistent proteinuria and/or hematuria.

            Results: Meta-analyses of 4 trials showed no significant difference in the risk of persistent kidney disease at 6 months (379 children; RR 0.54, 95% CI 0.25 to 1.18) 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 in 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.

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