Prevention and treatment of renal disease in Henoch-Schonlein purpura: a systematic review

Objective: To determine the benefits and harms of therapies used to prevent or treat renal involvement in Henoch-Schonlein 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 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-Schonlein 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-Schonlein purpura are very sparse except for short-term prednisone, which has not been shown to be effective.