Interventions for steroid-resistant nephrotic syndrome: a systematic review

被引:41
作者
Habashy, D
Hodson, EM
Craig, JC
机构
[1] Childrens Hosp Westmead, Ctr Kidney Res, Westmead, NSW 2145, Australia
[2] Childrens Hosp Westmead, Cochrane Renal Grp, NHMRC, Ctr Clin Res Excellence, Westmead, NSW 2145, Australia
[3] Univ Sydney, Sch Publ Hlth, Sydney, NSW 2006, Australia
关键词
steroid-resistant nephrotic syndrome; meta-analysis; corticosteroids; immunosuppressive agents; angiotensin-converting enzyme inhibitors;
D O I
10.1007/s00467-003-1207-0
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
In a systematic review and meta-analysis of randomized controlled trials (RCT), we aimed to evaluate the benefits and harms of all interventions for children with steroid-resistant nephrotic syndrome (SRNS). Nine RCTs involving 225 children were included. Cyclosporin when compared with placebo or no treatment significantly increased the number of children who achieved complete remission [3 trials, 49 children, relative risk (RR) for persistent nephrotic syndrome 0.64, 95% confidence intervals (CI), 0.47-0.88]. There was no significant difference in the number of children who achieved complete remission between oral cyclophosphamide with prednisone and prednisone alone [2 trials, 91 children, RR 1.01, 95% CI 0.74-1.36], between intravenous cyclophosphamide and oral cyclophosphamide [1 study, 11 children, RR 0.09, 95% CI 0.01-1.39], and between azathioprine with prednisone and prednisone alone [1 trial, 31 children, RR 1.01, 95% CI 0.77-1.32]. No RCTs were identified comparing combination regimens comprising high-dose steroids, alkylating agents or cyclosporin with single agents, placebo, or no treatment. Further adequately powered and well-designed RCTs are needed to confirm the efficacy of cyclosporin and to evaluate regimens of high-dose steroids with alkylating agents or cyclosporin for SRNS.
引用
收藏
页码:906 / 912
页数:7
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