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. 2022 Mar 1;3(3):CD001537.
doi: 10.1002/14651858.CD001537.pub5.

Interventions for minimal change disease in adults with nephrotic syndrome

Karolis Azukaitis  1 , Suetonia C Palmer  2 , Giovanni Fm Strippoli  3   4 , Elisabeth M Hodson  4
Affiliations

Interventions for minimal change disease in adults with nephrotic syndrome

Karolis Azukaitis et al. Cochrane Database Syst Rev. .

Abstract

Background: Steroids have been used widely since the early 1970s for the treatment of adult-onset minimal change disease (MCD). Recently, newer agents have been used in adult MCD aiming to reduce the risk of adverse effects. The response rates to immunosuppressive agents in adult MCD are more variable than in children. The optimal agent, dose, and duration of treatment for the first episode of nephrotic syndrome, or for disease relapse(s) have not been determined. This is an update of a review first published in 2008.

Objectives: We aimed to 1) evaluate the benefits and harms of different agents, including both immunosuppressive and non-immunosuppressive agents, in adults with MCD causing the nephrotic syndrome; and 2) evaluate the efficacy of interventions on 'time-to-remission' of nephrotic syndrome, in adults with MCD causing the nephrotic syndrome.

Search methods: We searched the Cochrane Kidney and Transplant Register of Studies up to 21 July 2021 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov.

Selection criteria: Randomised controlled trials (RCTs) and quasi-RCTs of any intervention for MCD with nephrotic syndrome in adults over 18 years were included. Studies comparing different types, routes, frequencies, and duration of immunosuppressive agents and non-immunosuppressive agents were assessed.

Data collection and analysis: Two authors independently assessed study quality and extracted data. Statistical analyses were performed using the random-effects model and results were expressed as a risk ratio (RR) for dichotomous outcomes, or mean difference (MD) for continuous data with 95% confidence intervals (CI). Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Main results: Fifteen RCTs (769 randomised participants) were identified; four studies evaluated different prednisolone regimens, eight studies evaluated the calcineurin inhibitors (CNIs) (tacrolimus or cyclosporin), two studies evaluated enteric-coated mycophenolate sodium (EC-MPS) and one study evaluated levamisole. In all but two studies of non-corticosteroid agents, reduced-dose prednisolone was given with the treatment agent and the comparator was high-dose prednisolone. In the risk of bias assessment, 11 and seven studies were at low risk of bias for sequence generation and allocation concealment, respectively. No studies were at low risk of performance bias and eight studies were at low risk of detection bias. Thirteen, 10 and six studies were at low risk of attrition bias, reporting bias and other bias, respectively. Compared with no specific treatment, it is uncertain whether prednisolone increases the number with complete remission (1 study, 28 participants: RR 1.44, 95% CI 0.95 to 2.19), complete or partial remission (1 study, 28 participants: RR 1.38, 95% CI 0.98 to 1.95), subsequent relapse (1 study, 28 participants: RR 0.75, 95% CI 0.48 to 1.17), or reduces the adverse effects because the certainty of the evidence is very low. Compared with oral prednisolone alone, it is uncertain whether intravenous methylprednisolone and prednisolone increase the number with complete remission (2 studies, 35 participants: RR 1.76, 95% CI 0.17 to 18.32; I² = 90%), relapse (two studies, 19 participants. RR 1.18, 95% CI 0.65 to 2.15; I² = 0%) or adverse events because the certainty of the evidence is very low. Compared with prednisolone alone, CNIs with reduced-dose prednisolone or without prednisolone probably make little or no difference to the number achieving complete remission (8 studies; 492 participants: RR 0.99, 95% CI 0.93 to 1.05; I² = 0%), complete or partial remission (4 studies, 269 participants: RR 1.01, 95% CI 0.96 to 1.05; I² = 0%), or relapse (7 studies; 422 participants: RR 0.73, 95% CI 0.51 to 1.03; I² = 0%) (moderate certainty evidence), may reduce the risk of obesity or Cushing's Syndrome (5 studies; 388 participants: RR 0.11, 95% CI 0.02 to 0.59; I² = 45%) and the risk of acne (4 studies; 270 participants: RR 0.15, 95% CI 0.03 to 0.67; I² = 0%) (low certainty evidence); and had uncertain effects on diabetes or hyperglycaemia, hypertension, and acute kidney injury (AKI) (low certainty evidence). Compared with prednisolone alone, EC-MPS with reduced-dose prednisolone probably make little or no difference to the number undergoing complete remission at 4 weeks (1 study, 114 participants: RR 1.12, 95% CI 0.84 to 1.50), and at 24 weeks probably make little or no difference to the number undergoing complete remission (2 studies, 134 participants: RR 1.12, 95% CI 0.84 to 1.38; I² = 0%) (moderate certainty evidence), complete or partial remission (2 studies 134 participants: RR 0.92, 95% CI 0.75 to 1.12; I² = 0%), relapse (2 studies, 83 participants: RR 0.50, 95% CI 0.07 to 3.74; I² = 56%) (low certainty evidence); or to the adverse events of new-onset glucose intolerance, death, or AKI (low certainty evidence). One study (24 participants) compared levamisole and prednisolone with prednisolone in patients with relapsing disease. The authors identified no differences in mean relapse rate or adverse effects but no standard deviations were provided.

Authors' conclusions: This updated review has identified evidence for the efficacy and adverse effects of CNIs and EC-MPS with or without reduced-dose prednisolone compared with prednisolone alone for the induction of remission in adults with MCD and nephrotic syndrome with some reductions in steroid-associated adverse events. RCT data on the efficacy and adverse effects of rituximab in adults with MCD are awaited. Further, adequately powered RCTs are required to determine the relative efficacies of CNIs and EC-MPS and to evaluate these medications in patients with relapsing or steroid-resistant disease.

Trial registration: ClinicalTrials.gov NCT01185197 NCT00982072 NCT01197040 NCT01763580 NCT03210688 NCT03298698 NCT02592798.

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Conflict of interest statement

  1. Karolis Azukaitis has declared they have no conflict of interest

  2. Suetonia C Palmer has declared they have no conflict of interest

  3. Giovanni FM Strippoli has declared they have no conflict of interest

  4. Elisabeth M Hodson has declared they have no conflict of interest

Prof Jonathan Craig was the sign‐off editor for this review update

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1: Steroids versus no specific treatment, Outcome 1: Remission
1.2
1.2. Analysis
Comparison 1: Steroids versus no specific treatment, Outcome 2: Relapse during follow‐up
1.3
1.3. Analysis
Comparison 1: Steroids versus no specific treatment, Outcome 3: Adverse events
2.1
2.1. Analysis
Comparison 2: Intravenous ± oral steroids versus oral steroids alone, Outcome 1: Complete remission
2.2
2.2. Analysis
Comparison 2: Intravenous ± oral steroids versus oral steroids alone, Outcome 2: Relapse during follow‐up
2.3
2.3. Analysis
Comparison 2: Intravenous ± oral steroids versus oral steroids alone, Outcome 3: Adverse effects
3.1
3.1. Analysis
Comparison 3: Calcineurin inhibitors ± oral steroids versus oral steroids alone, Outcome 1: Remission
3.2
3.2. Analysis
Comparison 3: Calcineurin inhibitors ± oral steroids versus oral steroids alone, Outcome 2: Complete remission stratified for steroid use with CNI
3.3
3.3. Analysis
Comparison 3: Calcineurin inhibitors ± oral steroids versus oral steroids alone, Outcome 3: Relapse
3.4
3.4. Analysis
Comparison 3: Calcineurin inhibitors ± oral steroids versus oral steroids alone, Outcome 4: Time to complete remission
3.5
3.5. Analysis
Comparison 3: Calcineurin inhibitors ± oral steroids versus oral steroids alone, Outcome 5: Adverse effects
4.1
4.1. Analysis
Comparison 4: Mycophenolate sodium + oral steroids versus oral steroids alone, Outcome 1: Complete remission
4.2
4.2. Analysis
Comparison 4: Mycophenolate sodium + oral steroids versus oral steroids alone, Outcome 2: Complete or partial remission
4.3
4.3. Analysis
Comparison 4: Mycophenolate sodium + oral steroids versus oral steroids alone, Outcome 3: Relapse by 24 weeks
4.4
4.4. Analysis
Comparison 4: Mycophenolate sodium + oral steroids versus oral steroids alone, Outcome 4: Adverse events
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Black 1970 {published data only}
    1. Black DA, Rose G, Brewer DB.Controlled trial of prednisone in adult patients with the nephrotic syndrome. British Medical Journal 1970;3(5720):421-6. [MEDLINE: ] - PMC - PubMed
Coggins 1986 {published data only}
    1. Coggins CH.Adult minimal change nephropathy: experience of the collaborative study of glomerular disease. Transactions of the American Clinical & Climatological Asoociation 1986;97:18-26. [MEDLINE: ] - PMC - PubMed
Eguchi 2010 {published data only}
    1. Eguchi A, Takei T, Yoshida T, Tsuchiya K, Nitta K.Combined cyclosporine and prednisolone therapy in adult patients with the first relapse of minimal-change nephrotic syndrome. Nephrology Dialysis Transplantation 2010;25(1):124-9. [MEDLINE: ] - PubMed
Imbasciati 1985 {published data only}
    1. Imbasciati E, Gusmano R, Edefonti A, Zucchelli P, Pozzi C, Grassi C, et al.Controlled trial of methylprednisolone pulses and low dose oral prednisone for the minimal change nephrotic syndrome. British Medical Journal Clinical Research Ed 1985;291(6505):1305-8. [MEDLINE: ] - PMC - PubMed
Inoue 2010 {published data only}
    1. Inoue Y, Nakayama T, Inui K, Yoshimura A.The combination of very low-dose prednisolone with cyclosporine as an initial treatment for minimal change nephrotic syndrome (MCNS) in adults [abstract no: F-PO1272]. Journal of the American Society of Nephrology 2010;21(Abstract Suppl):402A.
Kirubakaran 1984 {published data only}
    1. Kirubakaran MG, Jacob GK, Date A, Shastry JCM.A controlled trial of levamisole in frequently relapsing minimal change disease [abstract]. Kidney International 1984;26(2):240.
Li 2017b {published data only}
    1. Li X, Chen J.Tacrolimus monotherapy follows intravenous methyprednisolone in adults with minimal change nephrotic syndrome: a prospective, multi-centered, open, randomized, controlled trial [abstract no: TH-PO662]. Journal of the American Society of Nephrology 2015;26(Abstract Suppl):240A. - PMC - PubMed
    1. Li X, Liu Z, Wang L, Wang R, Ding G, Shi W, et al.Tacrolimus monotherapy after intravenous methylprednisolone in adults with minimal change nephrotic syndrome. Journal of the American Society of Nephrology 2017;28(4):1286-95. [MEDLINE: ] - PMC - PubMed
Ma 2019 {published data only}
    1. Ma MK, Yap DY, Li CL, Mok MM, Chan GC, Kwan LP, et al.Low-dose corticosteroid and mycophenolate for primary treatment of minimal change disease. QJM 2020;113(6):399-403. [MEDLINE: ] - PubMed
Medjeral‐Thomas 2020 {published data only}
    1. Medjeral-Thomas NR, Lawrence C, Condon M, Sood B, Warwicker P, Brown H, et al.Randomized, controlled trial of tacrolimus and prednisolone monotherapy for adults with de novo minimal change disease: a multicenter, randomized, controlled trial.[Erratum in: Clin J Am Soc Nephrol. 2020 Jul 1;15(7):1027; PMID: 32518101]. Clinical Journal of the American Society of Nephrology: CJASN 2020;15(2):209-18. [MEDLINE: ] - PMC - PubMed
Miao 2006 {published data only}
    1. Miao L, Sun J, Yuan H, Jia Y, Xu Z.Combined therapy of low-dose tacrolimus and prednisone in nephrotic syndrome with slight mesangial proliferation. Nephrology 2006;11(5):449-54. [MEDLINE: ] - PubMed
MSN 2018 {published data only}
    1. Remy P, Audard V, Natella PA, Pelle G, Dussol B, Leray-Moragues H, et al.An open-label randomized controlled trial of low-dose corticosteroid plus enteric-coated mycophenolate sodium versus standard corticosteroid treatment for minimal change nephrotic syndrome in adults (MSN Study). Kidney International 2018;94(6):1217-26. [MEDLINE: ] - PubMed
Patil 2019 {published data only}
    1. Patil MR, Divyaveer SS, Raychaudhary A, Trivedi M, Mahajan C, Sarkar D, et al.Tacrolimus as the first-line agent in adult-onset minimal change disease: A randomized controlled study. Saudi Journal of Kidney Diseases & Transplantation 2019;30(1):129-37. [MEDLINE: ] - PubMed
Shirai 2018 {published data only}
    1. Shirai S, Ichikawa D, Tsuruoka S, Imai N, Shibagaki Y, Sakurada T, et al.Combined cyclosporine and prednisolone therapy in adults with new-onset minimal change nephrotic syndrome [abstract no: TH-PO1003]. Journal of the American Society of Nephrology 2013;24(Abstracts):327A. [CENTRAL: CN-01657780]
    1. Shirai S, Imai N, Sueki S, Matsui K, Tominaga N, Sakurada T, et al.Combined cyclosporine and prednisolone therapy using cyclosporine blood concentration monitoring for adult patients with new-onset minimal change nephrotic syndrome: a single-center pilot randomized trial. Clinical & Experimental Nephrology 2018;22(2):283-90. [MEDLINE: ] - PubMed
T‐OPTIMUM 2021 {published data only}
    1. Chin HJ, Chae DW, Kim YC, An WS, Ihm C, Jin DC, et al.Comparison of the efficacy and safety of tacrolimus and low-dose corticosteroid with high-dose corticosteroid for minimal change nephrotic syndrome in adults. Journal of the American Society of Nephrology 2021;32(1):199-210. [MEDLINE: ] - PMC - PubMed
    1. Redacted clinical study report synopsis DSN: PRGNS-11-02-KOR. astellasclinicalstudyresults.com/docs/PRGNS-11-02-KOR/Redacted%20Synopsi... 10-03-2018.
Yeung 1983 {published data only}
    1. Yeung CK, Wong KL, Ng WL.Intravenous methylprednisolone pulse therapy in minimal change nephrotic syndrome. Australian & New Zealand Journal of Medicine 1983;13(4):349-51. [MEDLINE: ] - PubMed

References to studies excluded from this review

Edefonti 1988 {published data only}
    1. Edefonti A, Ghio L, Bettinelli A, Paterlini G, Giani M, Nebbia G, et al.Unconjugated hyperbilirubinemia due to ciclosporin administration in children with nephrotic syndrome. Contributions to Nephrology 1988;67:121-4. [MEDLINE: ] - PubMed
    1. Edefonti A, Ghio L, Bettinelli A, Paterlini G, Giani M, Nebbia G, et al.Unconjugated hyperbilirubinemia due to cyclosporin a (CyA) administration in children with nephrotic syndrome (NS) [abstract no: F1.12]. Pediatric Nephrology 1987;1(4):C8. [CENTRAL: CN-00465774] - PubMed
    1. Edefonti A, Ghio L, Rizzoni G, Rinaldi S, Gusmano R, Lama G, et al.Cyclosporine (CSA) vs cyclophosphamide (CYC) for children with frequently relapsing/steroid dependant nephrotic syndrome (FR/SDNS): long term study [abstract]. In: 9th Congress. International Pediatric Nephrology Association; 1992 Aug 30 - Sep 4; Jerusalem, Israel. 1992:C70. [CENTRAL: CN-00483820]
    1. Edefonti A, Ghio L, Rizzoni G, Rinaldi S, Gusmano R, Lama G, et al.Cyclosporine (CSA) vs cyclophosphamide (CYC) for children with frequently relapsing/steroid dependent nephrotic syndrome (FR/SDNS): long term study [abstract]. Journal of the American Society of Nephrology 1992;3(3):310. [CENTRAL: CN-00460680]
    1. Ponticelli C, Edefonti A, Ghio L, Rizzoni G, Rinaldi S, Gusmano R et al.Cyclosporin versus cyclophosphamide for patients with steroid-dependent and frequently relapsing idiopathic nephrotic syndrome: a multicentre randomized controlled trial. Nephrology Dialysis Transplantation 1993;8(12):1326-32. [MEDLINE: ] - PubMed
Li 2008a {published data only}
    1. Li X, Tian J, Chen J.Mycophenolate mofetil combined with low dose of prednisolone in treating adults with minimal change nephrotic syndrome and concomitant HBsAg positive [abstract no: TH-PO865]. Journal of the American Society of Nephrology 2008;19(Abstract Suppl):305A. [CENTRAL: CN-01658379]
Ponticelli 1993a {published data only}
    1. Ponticelli C, Rizzoni G, Edefonti A, Altieri P, Rivolta E, Rinaldi S et al.A randomized trial of cyclosporine in steroid resistant idiopathic nephrotic syndrome. Kidney International 1993;43(6):1377-84. [MEDLINE: ] - PubMed
Simon 1989 {published data only}
    1. Simon P, Meyrier A.One-year, alternate day dosage, corticosteroid Rx reduces rate of further relapses in adult minimal change nephrosis [abstract]. Kidney International 1989;35(1):201. [CENTRAL: CN-01657781]

References to ongoing studies

ADAPTinMCN 2018 {published data only}
    1. Kristensen T, Birn H, Ivarsen P.A randomised controlled unblinded multicentre non-inferiority trial with activated vitamin D and prednisolone treatment in patients with minimal change nephropathy (ADAPTinMCN). Trials [Electronic Resource] 2021;22(1):442. [MEDLINE: ] - PMC - PubMed
    1. Kristensen T, Birn H, Ivarsen P.A randomized controlled, Danish multicenter trial in minimal change nephropathy: The efficacy of high dose prednisolone vs. reduced prednisolone dose and activated vitamin D [abstract no: SP180]. Nephrology Dialysis Transplantation 2018;33(Suppl 1):i405. [EMBASE: 622606298]
CTRI/2015/12/006439 {published data only}
    1. Ramachandran R.Steroid tapering protocol in adult nephrotic syndrome due to MCD- a randomised control trial of 2 regimens - MCD [Comparison of 2 steroid tapering protocol in adult minimal change disease]. www.ctri.nic.in/Clinicaltrials/pmaindet2 php?trialid=13216 (first received 16 December 2015).
NCT03298698 {published data only}
    1. Deegens HK, Wetzels JF.Efficacy of rituximab in comparison to continued corticosteroid treatment in idiopathic nephrotic syndrome [Efficacy of rituximab in comparison to continued corticosteroid treatment in idiopathic nephrotic syndrome unresponsive to 8 weeks of high dose prednisone]. www.ClinicalTrials.gov/show/NCT03298698 (first received 2 October 2017).
Trachtman 2018 {published data only}
    1. Trachtman H, Gipson DS, Somers M, Spino C, Adler S, Holzman L, et al.Randomized clinical trial design to assess abatacept in resistant nephrotic syndrome. Kidney International Reports 2018;3(1):115-21. [MEDLINE: ] - PMC - PubMed
TURING 2019 {published data only}16948923
    1. Qian W, Machin A, Griffith M, Willcocks L.Analysis of duration of remission as an intention-to-treat analysis with application to the TURING trial [abstract no: P-194]. Trials [Electronic Resource] 2019;20(Suppl 1):56. [EMBASE: 629759857]
    1. Willcocks L, Griffith M.TURING - the use of rituximab in the treatment of nephrotic glomerulonephritis - clinical trial protocol V2.0. njl-admin.nihr.ac.uk/document/download/2030929 (accessed 20 December 2021).

Additional references

Canetta 2015
    1. Canetta PAA, Radhakrishnan J.The evidence-based approach to adult-onset idiopathic nephrotic syndrome. Frontiers in Pediatrics 2015;3:78. [MEDLINE: ] - PMC - PubMed
Gesualdo 2004
    1. Gesualdo L, Di Palma AM, Morrone LF, Strippoli GF, Schena FP, Italian Immunopathology Group, Italian Society of Nephrology.The Italian experience of the national registry of renal biopsies. Kidney International 2004;66:890-4. [MEDLINE: ] - PubMed
GRADE 2008
    1. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al.GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336(7650):924-6. [MEDLINE: ] - PMC - PubMed
GRADE 2011
    1. Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al.GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. Journal of Clinical Epidemiology 2011;64(4):383-94. [MEDLINE: ] - PubMed
Grimbert 2003
    1. Grimbert P, Audard V, Remy P, Lang P, Sahali D.Recent approaches to the pathogenesis of minimal-change nephrotic syndrome. Nephrology Dialysis Transplantation 2003;18(2):245-8. [MEDLINE: ] - PubMed
Haas 1995
    1. Haas M, Spargo BH, Coventry S.Increasing incidence of focal-segmental glomerulosclerosis among adult nephropathies: a 20-year renal biopsy study. American Journal of Kidney Diseases 1995;26(5):740-50. [MEDLINE: ] - PubMed
Haas 1997
    1. Haas M, Meehan SM, Karrison TG, Spargo BH.Changing etiologies of unexplained adult nephrotic syndrome: a comparison of renal biopsy findings from 1976-1979 and 1995-1997. American Journal of Kidney Diseases 1997;30(5):621-31. [MEDLINE: ] - PubMed
Hahn 2020
    1. Hahn D, Samuel SM, Willis NS, Craig JC, Hodson EM.Corticosteroid therapy for nephrotic syndrome in children. Cochrane Database of Systematic Reviews 2020, Issue 8. Art. No: CD001533. [DOI: 10.1002/14651858.CD001533.pub6] - DOI - PMC - PubMed
Higgins 2003
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG.Measuring inconsistency in meta-analyses. BMJ 2003;327(7414):557-60. [MEDLINE: ] - PMC - PubMed
Higgins 2020
    1. Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors).Cochrane Handbook for Systematic Reviews of Interventions version 6.1 (updated September 2020). Cochrane, 2020. Available from www.training.cochrane.org/handbook.
Hogan 2013
    1. Hogan J, Radhakrishnan J.The treatment of minimal change disease in adults. Journal of the American Society of Nephrology 2013;24(5):702–11. [MEDLINE: ] - PubMed
KDIGO 2021
    1. Chapter 5: Minimal change disease (MCD) in adults. Kidney International Supplements 2021;100(4S):S153-60. [DOI: 10.1016/j.kint.2021.05.021] - DOI - PMC - PubMed
Korbet 1996
    1. Korbet SM, Genchi RM, Borok RZ, Schwartz MM.The racial prevalence of glomerular lesions in nephrotic adults. American Journal of Kidney Diseases 1996;27(5):647-51. [MEDLINE: ] - PubMed
Korbet 2019
    1. Korbet SM, Whittier WL.Management of adult minimal change disease. Clinical Journal of The American Society of Nephrology: CJASN 2019;14(6):911–3. [MEDLINE: ] - PMC - PubMed
Larkins 2020
    1. Larkins NG, Liu ID, Willis NS, Craig JC, Hodson EM.Non-corticosteroid immunosuppressive medications for steroid-sensitive nephrotic syndrome in children. Cochrane Database of Systematic Reviews 2020, Issue 4. Art. No: CD002290. [DOI: 10.1002/14651858.CD002290.pub5] - DOI - PMC - PubMed
Liu 2019
    1. Liu ID, Willis NS, Craig JC, Hodson EM.Interventions for idiopathic steroid-resistant nephrotic syndrome in children. Cochrane Database of Systematic Reviews 2019, Issue 11. Art. No: CD003594. [DOI: 10.1002/14651858.CD003594.pub6] - DOI - PMC - PubMed
Mühlig 2019
    1. Mühlig AK, Lee JY, Kemper MJ, Kronbichler A, Yang JW, Lee JM, et al.Levamisole in children with idiopathic nephrotic syndrome: clinical efficacy and pathophysiological aspects. Journal of Clinical Medicine 2019;8(6):860. [MEDLINE: ] - PMC - PubMed
Munyentwali 2013
    1. Munyentwali H, Bouachi K, Audard V, Remy P, Lang P, Mojaat R, et al.Rituximab is an efficient and safe treatment in adults with steroid-dependent minimal change disease. Kidney International 2013;83(3):511-6. [MEDLINE: ] - PubMed
Nakayama 2002
    1. Nakayama M, Katafuchi R, Yanase T, Ikeda K, Tanaka H, Fuijimi S.Steroid responsiveness and frequency of relapse in adult-onset minimal change nephrotic syndrome. American Journal of Kidney Diseases 2002;39(3):503-12. [MEDLINE: ] - PubMed
Nolasco 1986
    1. Nolasco F, Cameron JS, Heywood EF, Hicks J, Ogg C, Williams DG.Adult-onset minimal change nephrotic syndrome: a long-term follow-up. Kidney International 1986;29(6):1215-23. [MEDLINE: ] - PubMed
Reddy 2016
    1. Reddy V, Dahal LN, Cragg MS, Leandro M.Optimising B-cell depletion in autoimmune disease: is obinutuzumab the answer? Drug Discovery Today 2016;21(8):1330-8. [MEDLINE: ] - PubMed
Schijvens 2019
    1. Schijvens AM, Ter Heine R, Wildt SN, Schreuder MF.Pharmacology and pharmacogenetics of prednisone and prednisolone in patients with nephrotic syndrome. Pediatric Nephrology 2019;34(3):389-403. [MEDLINE: ] - PMC - PubMed
Schünemann 2020a
    1. Schünemann HJ, Higgins JP, Vist GE, Glasziou P, Akl EA, Skoetz N, et al.Chapter 14: Completing ‘Summary of findings’ tables and grading the certainty of the evidence. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.1 (updated September 2020). Cochrane, 2020. Available from www.training.cochrane.org/handbook.
Schünemann 2020b
    1. Schünemann HJ, Vist GE, Higgins JP, Santesso N, Deeks JJ, Glasziou P, et al.Chapter 15: Interpreting results and drawing conclusions. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.1 (updated September 2020). Cochrane, 2020. Available from www.training.cochrane.org/handbook.
Tse 2003
    1. Tse KC, Lam MF, Yip PS, Li FK, Choy BY, Lai KN, et al.Idiopathic minimal change nephrotic syndrome in older adults: steroid responsiveness and pattern of relapses. Nephrology Dialysis Transplantation 2003;18(7):1316-20. [MEDLINE: ] - PubMed
Vivarelli 2017
    1. Vivarelli M, Massella L, Ruggiero B, Emma F.Minimal change disease. Clinical Journal of The American Society of Nephrology: CJASN 2017;12(2):332–45. [MEDLINE: ] - PMC - PubMed
Waldman 2007
    1. Waldman M, Crew RJ, Valeri A, Busch J, Stokes B, Markowitz G, et al.Adult minimal-change disease: clinical characteristics,treatment, and outcomes. Clinical Journal of The American Society of Nephrology: CJASN 2007;2(3):445-53. [MEDLINE: ] - PubMed

References to other published versions of this review

Palmer 2006
    1. Palmer SC, Nand K, Strippoli GF.Interventions for minimal change disease in adults with nephrotic syndrome. Cochrane Database of Systematic Reviews 2006, Issue 7. Art. No: CD001537. [DOI: 10.1002/14651858.CD001537.pub3] - DOI - PMC - PubMed
Palmer 2008
    1. Palmer SC, Nand K, Strippoli GF.Interventions for minimal change disease in adults with nephrotic syndrome. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No: CD001537. [DOI: 10.1002/14651858.CD001537.pub4] - DOI - PMC - PubMed

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