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Cochrane Database of Systematic Reviews

Intervenciones para la prevención y el tratamiento de las afecciones renales en la púrpura de Schönlein‐Henoch (PSH)

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Information

DOI:
https://doi.org/10.1002/14651858.CD005128.pub3Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 07 August 2015see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:
  1. Cochrane Kidney and Transplant Group

Copyright:
  1. Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

  • Deirdre Hahn

    Department of Nephrology, The Children's Hospital at Westmead, Westmead, Australia

  • Elisabeth M Hodson

    Correspondence to: Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia

    [email protected]

    Sydney School of Public Health, The University of Sydney, Sydney, Australia

  • Narelle S Willis

    Sydney School of Public Health, The University of Sydney, Sydney, Australia

    Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia

  • Jonathan C Craig

    Sydney School of Public Health, The University of Sydney, Sydney, Australia

    Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia

Contributions of authors

  • Wattana Chartapisak: study selection, quality appraisal, data extraction, data analysis, writing original protocol, writing original review.

  • Sauwalak Opastrirakul: study selection, quality appraisal, data extraction, writing original protocol

  • Elisabeth Hodson: study selection, quality appraisal, data extraction, data analysis, writing original protocol, writing original review, updating review.

  • Narelle Willis: reviewing protocol and review, data analysis

  • Jonathan Craig: writing review, disagreement resolution

  • Deirdre Hahn: study selection, quality appraisal, data extraction, data analysis, writing of manuscript for update of review

Declarations of interest

  • Deirdre Hahn: nothing to declare

  • Elisabeth Hodson: nothing to declare

  • Narelle Willis: nothing to declare

  • Jonathan Craig: nothing to declare

Acknowledgements

  • We thank Dr Dudley, Dr Smith and Dr Tizard for additional information on their RCT. We thank Dr Ronkainen, Dr Nuutinen and Dr Mara Medeiros for additional information on their RCTs

  • We acknowledge the contributions made by authors Wattana Chartapisak and Sauwalak Opastrirakul to a previous version of this review

  • We would like to thank Drs Michael Dillon, Matti Nuutinen and Lesley Rees for their editorial advice during the preparation of this review

  • This work was presented in part at the 42nd Annual Scientific Meeting of the Australian and New Zealand Society of Nephrology (Melbourne 2006)

  • We would like to thank Sunny Wu for translating one paper.

Version history

Published

Title

Stage

Authors

Version

2023 Feb 28

Interventions for preventing and treating kidney disease in IgA vasculitis

Review

Deirdre Hahn, Elisabeth M Hodson, Jonathan C Craig

https://doi.org/10.1002/14651858.CD005128.pub4

2015 Aug 07

Interventions for preventing and treating kidney disease in Henoch‐Schönlein Purpura (HSP)

Review

Deirdre Hahn, Elisabeth M Hodson, Narelle S Willis, Jonathan C Craig

https://doi.org/10.1002/14651858.CD005128.pub3

2009 Jul 08

Interventions for preventing and treating kidney disease in Henoch‐Schönlein Purpura (HSP)

Review

Wattana Chartapisak, Sauwalak Opastirakul, Elisabeth M Hodson, Narelle S Willis, Jonathan C Craig

https://doi.org/10.1002/14651858.CD005128.pub2

2005 Jan 24

Interventions for preventing and treating renal disease in Henoch‐Schönlein Purpura (HSP)

Protocol

Wattana Chartapisak, Sauwalak Opastirakul, Elisabeth M Hodson, Narelle S Willis, Jonathan C Craig

https://doi.org/10.1002/14651858.CD005128

Differences between protocol and review

New methodology for assessing the risk of bias has replaced the quality assessment checklist. Studies of therapies with herbal treatments and non‐pharmacological interventions were excluded.

Keywords

MeSH

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Flow diagram of included and excluded study in Review
Figures and Tables -
Figure 1

Flow diagram of included and excluded study in Review

Risk of bias: Review authors' judgements about each methodological quality item presented as percentages across all included studies.
Figures and Tables -
Figure 2

Risk of bias: Review authors' judgements about each methodological quality item presented as percentages across all included studies.

Risk of bias: Review authors' judgements about each risk of bias item for each included study
Figures and Tables -
Figure 3

Risk of bias: Review authors' judgements about each risk of bias item for each included study

Comparison 1 Prednisone versus placebo/supportive treatment for preventing persistent kidney disease, Outcome 1 Persistent kidney disease at any time after treatment.
Figures and Tables -
Analysis 1.1

Comparison 1 Prednisone versus placebo/supportive treatment for preventing persistent kidney disease, Outcome 1 Persistent kidney disease at any time after treatment.

Comparison 1 Prednisone versus placebo/supportive treatment for preventing persistent kidney disease, Outcome 2 Number of children with any continuing kidney disease at different time points.
Figures and Tables -
Analysis 1.2

Comparison 1 Prednisone versus placebo/supportive treatment for preventing persistent kidney disease, Outcome 2 Number of children with any continuing kidney disease at different time points.

Comparison 1 Prednisone versus placebo/supportive treatment for preventing persistent kidney disease, Outcome 3 Any continuing kidney disease at different time points (study with high risk of bias excluded).
Figures and Tables -
Analysis 1.3

Comparison 1 Prednisone versus placebo/supportive treatment for preventing persistent kidney disease, Outcome 3 Any continuing kidney disease at different time points (study with high risk of bias excluded).

Comparison 1 Prednisone versus placebo/supportive treatment for preventing persistent kidney disease, Outcome 4 Number of children with kidney disease in first month/with kidney disease at follow‐up.
Figures and Tables -
Analysis 1.4

Comparison 1 Prednisone versus placebo/supportive treatment for preventing persistent kidney disease, Outcome 4 Number of children with kidney disease in first month/with kidney disease at follow‐up.

Comparison 1 Prednisone versus placebo/supportive treatment for preventing persistent kidney disease, Outcome 5 Number developing severe kidney disease.
Figures and Tables -
Analysis 1.5

Comparison 1 Prednisone versus placebo/supportive treatment for preventing persistent kidney disease, Outcome 5 Number developing severe kidney disease.

Comparison 1 Prednisone versus placebo/supportive treatment for preventing persistent kidney disease, Outcome 6 Duration of kidney disease.
Figures and Tables -
Analysis 1.6

Comparison 1 Prednisone versus placebo/supportive treatment for preventing persistent kidney disease, Outcome 6 Duration of kidney disease.

Comparison 1 Prednisone versus placebo/supportive treatment for preventing persistent kidney disease, Outcome 7 Gastrointestinal complications requiring hospital admission.
Figures and Tables -
Analysis 1.7

Comparison 1 Prednisone versus placebo/supportive treatment for preventing persistent kidney disease, Outcome 7 Gastrointestinal complications requiring hospital admission.

Comparison 1 Prednisone versus placebo/supportive treatment for preventing persistent kidney disease, Outcome 8 Eight‐year outcomes.
Figures and Tables -
Analysis 1.8

Comparison 1 Prednisone versus placebo/supportive treatment for preventing persistent kidney disease, Outcome 8 Eight‐year outcomes.

Comparison 2 Antiplatelet agents versus supportive treatment for preventing persistent kidney disease, Outcome 1 Kidney disease at any time.
Figures and Tables -
Analysis 2.1

Comparison 2 Antiplatelet agents versus supportive treatment for preventing persistent kidney disease, Outcome 1 Kidney disease at any time.

Comparison 2 Antiplatelet agents versus supportive treatment for preventing persistent kidney disease, Outcome 2 Kidney disease at any time.
Figures and Tables -
Analysis 2.2

Comparison 2 Antiplatelet agents versus supportive treatment for preventing persistent kidney disease, Outcome 2 Kidney disease at any time.

Comparison 3 Heparin versus placebo for preventing persistent kidney disease, Outcome 1 Any kidney disease at 3 months after onset or relapse.
Figures and Tables -
Analysis 3.1

Comparison 3 Heparin versus placebo for preventing persistent kidney disease, Outcome 1 Any kidney disease at 3 months after onset or relapse.

Comparison 3 Heparin versus placebo for preventing persistent kidney disease, Outcome 2 Type of kidney disease at 3 months or more after onset or relapse.
Figures and Tables -
Analysis 3.2

Comparison 3 Heparin versus placebo for preventing persistent kidney disease, Outcome 2 Type of kidney disease at 3 months or more after onset or relapse.

Comparison 3 Heparin versus placebo for preventing persistent kidney disease, Outcome 3 Time to development of kidney disease.
Figures and Tables -
Analysis 3.3

Comparison 3 Heparin versus placebo for preventing persistent kidney disease, Outcome 3 Time to development of kidney disease.

Comparison 4 Cyclophosphamide versus supportive treatment for treating severe kidney disease, Outcome 1 Persistent kidney disease.
Figures and Tables -
Analysis 4.1

Comparison 4 Cyclophosphamide versus supportive treatment for treating severe kidney disease, Outcome 1 Persistent kidney disease.

Comparison 4 Cyclophosphamide versus supportive treatment for treating severe kidney disease, Outcome 2 Persistent severe kidney disease.
Figures and Tables -
Analysis 4.2

Comparison 4 Cyclophosphamide versus supportive treatment for treating severe kidney disease, Outcome 2 Persistent severe kidney disease.

Comparison 4 Cyclophosphamide versus supportive treatment for treating severe kidney disease, Outcome 3 ESKD.
Figures and Tables -
Analysis 4.3

Comparison 4 Cyclophosphamide versus supportive treatment for treating severe kidney disease, Outcome 3 ESKD.

Comparison 5 Cyclophosphamide + steroids versus steroids, Outcome 1 Primary outcome: BVAS at 6 months.
Figures and Tables -
Analysis 5.1

Comparison 5 Cyclophosphamide + steroids versus steroids, Outcome 1 Primary outcome: BVAS at 6 months.

Comparison 5 Cyclophosphamide + steroids versus steroids, Outcome 2 Secondary endpoints at 12 months.
Figures and Tables -
Analysis 5.2

Comparison 5 Cyclophosphamide + steroids versus steroids, Outcome 2 Secondary endpoints at 12 months.

Comparison 5 Cyclophosphamide + steroids versus steroids, Outcome 3 Adverse effects.
Figures and Tables -
Analysis 5.3

Comparison 5 Cyclophosphamide + steroids versus steroids, Outcome 3 Adverse effects.

Comparison 6 Cyclosporin versus methylprednisolone for treating severe kidney disease, Outcome 1 Number with remission at 3 months.
Figures and Tables -
Analysis 6.1

Comparison 6 Cyclosporin versus methylprednisolone for treating severe kidney disease, Outcome 1 Number with remission at 3 months.

Comparison 6 Cyclosporin versus methylprednisolone for treating severe kidney disease, Outcome 2 Number with remission at last follow‐up (mean 6.3 years).
Figures and Tables -
Analysis 6.2

Comparison 6 Cyclosporin versus methylprednisolone for treating severe kidney disease, Outcome 2 Number with remission at last follow‐up (mean 6.3 years).

Comparison 7 Mycophenolate mofetil versus azathioprine for treating severe kidney disease, Outcome 1 Remission of proteinuria at 1 year.
Figures and Tables -
Analysis 7.1

Comparison 7 Mycophenolate mofetil versus azathioprine for treating severe kidney disease, Outcome 1 Remission of proteinuria at 1 year.

Comparison 7 Mycophenolate mofetil versus azathioprine for treating severe kidney disease, Outcome 2 Regression of histological lesions at 1 year.
Figures and Tables -
Analysis 7.2

Comparison 7 Mycophenolate mofetil versus azathioprine for treating severe kidney disease, Outcome 2 Regression of histological lesions at 1 year.

Comparison 8 Fosinopril + supportive treatment versus supportive treatment, Outcome 1 Proteinuria.
Figures and Tables -
Analysis 8.1

Comparison 8 Fosinopril + supportive treatment versus supportive treatment, Outcome 1 Proteinuria.

Summary of findings for the main comparison. Prednisone versus placebo or supportive treatment for preventing persistent kidney disease in patients with Henoch‐Schönlein Purpura (HSP)

Prednisone versus placebo or supportive treatment for preventing persistent kidney disease in patients with Henoch‐Schönlein Purpura (HSP)

Patient or population: patients with HSP
Settings: all settings
Intervention: prednisone
Comparison: placebo or supportive treatment

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Placebo or supportive treatment

Prednisone

Persistent kidney disease at any time after treatment

Study population

RR 0.74
(0.42 to 1.32)

746 (5)

⊕⊕⊕⊝
moderate1

143 per 1000

106 per 1000
(60 to 189)

Moderate

105 per 1000

78 per 1000
(44 to 139)

Number of children with any continuing kidney disease at 3 months

Study population

RR 0.83
(0.46 to 1.52)

655 (4)

⊕⊕⊕⊝
moderate2

199 per 1000

165 per 1000
(92 to 303)

Moderate

156 per 1000

129 per 1000
(72 to 237)

Number of children with any continuing kidney disease at 6 months

Study population

RR 0.51
(0.24 to 1.11)

379 (3)

⊕⊕⊕⊝
moderate2

100 per 1000

51 per 1000
(24 to 111)

Moderate

53 per 1000

27 per 1000
(13 to 59)

Number of children with any continuing kidney disease at 12 months

Study population

RR 1.06
(0.38 to 2.91)

455 (3)

⊕⊕⊝⊝
low2,3

84 per 1000

89 per 1000
(32 to 244)

Moderate

105 per 1000

111 per 1000
(40 to 306)

Any continuing kidney disease at 3 months (study with high risk of bias excluded)

Study population

RR 0.98
(0.7 to 1.36)

487 (3)

⊕⊕⊕⊕
high

243 per 1000

238 per 1000
(170 to 330)

Moderate

207 per 1000

203 per 1000
(145 to 282)

Any continuing kidney disease at 12 months (study with high risk of bias excluded)

Study population

RR 1.39
(0.75 to 2.59)

287 (2)

⊕⊕⊕⊝
moderate3,4

105 per 1000

146 per 1000
(79 to 272)

Moderate

105 per 1000

146 per 1000
(79 to 272)

Number developing severe kidney disease

Study population

RR 1.58
(0.42 to 6)

418 (2)

⊕⊕⊝⊝
low3,5

14 per 1000

22 per 1000
(6 to 85)

Moderate

17 per 1000

27 per 1000
(7 to 102)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; RR: risk ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate
Very low quality: We are very uncertain about the estimate

1 Two studies had unclear or biased allocation concealment & were not blinded
2 One study had inadequate allocation concealment & no blinding & one study had large loss to follow‐up
3 30% loss to follow‐up in largest included study
4 Small numbers of patients and events
5 Small numbers of events

Figures and Tables -
Summary of findings for the main comparison. Prednisone versus placebo or supportive treatment for preventing persistent kidney disease in patients with Henoch‐Schönlein Purpura (HSP)
Table 1. Definition of kidney disease used in outcome assessment

Study

Timing of outcome

Haematuria

Proteinuria

Blood pressure

Kidney function

Dudley 2013

1, 3 and 12 months

Any level on dipstick

UPC > 20 mg/mmol

Dipstick for protein

Not defined

Not defined

Huber 2004

1, 3, 6 and 12 months

≥ 5 RBC/HPF or RBC casts

> 300 mg/L on dipstick

> 90th percentile for age and sex

Elevated Cr

Islek 1999

Unclear

Not defined

Not defined

Not defined

Not defined

Mollica 1992

1, 3, 6 and 12 months

≥ 10 RBC/HPF

≥ 4 mg/m²/h

> 2 SD above normal

Cr ≥ 0.8 mg/dL/mm²

Peratoner 1990

During initial 12 months

> 5 RBC/mm²

Not defined

Not defined

Reduced GFR

Ronkainen 2006a

1, 3 and 6 months

> 5 RBC/HPF

> 200 mg/L or urinary albumin > 30 mg/L

Not defined

Not defined

Jauhola 2010

2 years

Not defined

Remission: UPC < 200 mg/mmol or daily urine protein < 40 mg/m²/d

Not defined

Not defined

Tarshish 2004

Mean follow‐up to 7 years

Addis Count > 30,000 RBC/h/m² or ≥ 1+ on dipstick ≥ 3 cells/HPF or > 2 RBC/mm³

> 4 mg/h/m² or 2+ or more by dipstick

Heavy proteinuria > 40 mg/h/m²

Not defined

GFR < 80 mL/min/1.73 m²

ESKD

He 2002

Unclear

Not defined

Not defined

Not defined

Not defined

Yoshimoto 1987a

Unclear

Not defined

Not defined

Not defined

Not defined

Yoshimoto 1987b

Unclear

Not defined

Not defined

Not defined

Not defined

Cr ‐ creatinine; ESKD ‐ end‐stage kidney disease; GFR ‐ glomerular filtration rate; HPF ‐ high power field; UPC ‐ urinary protein:creatinine ratio; RBC ‐ red blood cell

Figures and Tables -
Table 1. Definition of kidney disease used in outcome assessment
Comparison 1. Prednisone versus placebo/supportive treatment for preventing persistent kidney disease

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Persistent kidney disease at any time after treatment Show forest plot

5

746

Risk Ratio (M‐H, Random, 95% CI)

0.74 [0.42, 1.32]

2 Number of children with any continuing kidney disease at different time points Show forest plot

4

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

2.1 One month

4

655

Risk Ratio (M‐H, Random, 95% CI)

0.80 [0.34, 1.84]

2.2 Three months

4

655

Risk Ratio (M‐H, Random, 95% CI)

0.83 [0.46, 1.52]

2.3 Six months

3

379

Risk Ratio (M‐H, Random, 95% CI)

0.51 [0.24, 1.11]

2.4 Twelve months

3

455

Risk Ratio (M‐H, Random, 95% CI)

1.06 [0.38, 2.91]

3 Any continuing kidney disease at different time points (study with high risk of bias excluded) Show forest plot

3

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

3.1 One month

3

487

Risk Ratio (M‐H, Random, 95% CI)

1.02 [0.54, 1.93]

3.2 Three months

3

487

Risk Ratio (M‐H, Random, 95% CI)

0.98 [0.70, 1.36]

3.3 Six months

2

211

Risk Ratio (M‐H, Random, 95% CI)

0.59 [0.23, 1.50]

3.4 Twelve months

2

287

Risk Ratio (M‐H, Random, 95% CI)

1.39 [0.75, 2.59]

4 Number of children with kidney disease in first month/with kidney disease at follow‐up Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

4.1 One month

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4.2 Three months

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4.3 Six months

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5 Number developing severe kidney disease Show forest plot

2

418

Risk Ratio (M‐H, Random, 95% CI)

1.58 [0.42, 6.00]

6 Duration of kidney disease Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

6.1 Haematuria

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

6.2 Proteinuria

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

7 Gastrointestinal complications requiring hospital admission Show forest plot

3

517

Risk Ratio (M‐H, Random, 95% CI)

0.56 [0.25, 1.23]

8 Eight‐year outcomes Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

8.1 Haematuria

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

8.2 Proteinuria

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

8.3 Haematuria and proteinuria

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

8.4 Hypertension

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

8.5 Decreased GFR (Schwartz formula)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 1. Prednisone versus placebo/supportive treatment for preventing persistent kidney disease
Comparison 2. Antiplatelet agents versus supportive treatment for preventing persistent kidney disease

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Kidney disease at any time Show forest plot

2

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

1.1 Dipyridamole ± cyproheptadine in children without kidney disease at entry

2

101

Risk Ratio (M‐H, Random, 95% CI)

1.16 [0.46, 2.95]

1.2 Dipyridamole ± cyproheptadine in children with kidney disease at entry

1

19

Risk Ratio (M‐H, Random, 95% CI)

0.92 [0.23, 3.72]

2 Kidney disease at any time Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2.1 Aspirin versus supportive treatment

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 2. Antiplatelet agents versus supportive treatment for preventing persistent kidney disease
Comparison 3. Heparin versus placebo for preventing persistent kidney disease

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Any kidney disease at 3 months after onset or relapse Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2 Type of kidney disease at 3 months or more after onset or relapse Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2.1 Haematuria

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.2 Proteinuria

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.3 Nephrotic syndrome

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3 Time to development of kidney disease Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Subtotals only

Figures and Tables -
Comparison 3. Heparin versus placebo for preventing persistent kidney disease
Comparison 4. Cyclophosphamide versus supportive treatment for treating severe kidney disease

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Persistent kidney disease Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

2 Persistent severe kidney disease Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

3 ESKD Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

Figures and Tables -
Comparison 4. Cyclophosphamide versus supportive treatment for treating severe kidney disease
Comparison 5. Cyclophosphamide + steroids versus steroids

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: BVAS at 6 months Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

1.1 BVAS = 0 at 6 months

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.2 Improvement in BVAS score

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2 Secondary endpoints at 12 months Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2.1 BP > 125/75 mm Hg

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.2 eGFR < 60 mL/min

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.3 Proteinuria > 1 g/d

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.4 RAS blockers

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.5 Kidney function improvement > 50%

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.6 ESKD

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.7 Mortality

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3 Adverse effects Show forest plot

1

Risk Difference (M‐H, Random, 95% CI)

Totals not selected

3.1 infection

1

Risk Difference (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3.2 Newly diagnosed or deterioration in existing diabetes

1

Risk Difference (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3.3 Depression/anxiety

1

Risk Difference (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3.4 Alopecia

1

Risk Difference (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3.5 Insomnia

1

Risk Difference (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 5. Cyclophosphamide + steroids versus steroids
Comparison 6. Cyclosporin versus methylprednisolone for treating severe kidney disease

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number with remission at 3 months Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

2 Number with remission at last follow‐up (mean 6.3 years) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

Figures and Tables -
Comparison 6. Cyclosporin versus methylprednisolone for treating severe kidney disease
Comparison 7. Mycophenolate mofetil versus azathioprine for treating severe kidney disease

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Remission of proteinuria at 1 year Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2 Regression of histological lesions at 1 year Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figures and Tables -
Comparison 7. Mycophenolate mofetil versus azathioprine for treating severe kidney disease
Comparison 8. Fosinopril + supportive treatment versus supportive treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Proteinuria Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

1.1 Complete remission of proteinuria < 150 mg/d

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.2 Partial remission

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.3 Minimal response/no response

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 8. Fosinopril + supportive treatment versus supportive treatment