Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Feb 28;2(2):CD005128.
doi: 10.1002/14651858.CD005128.pub4.

Interventions for preventing and treating kidney disease in IgA vasculitis

Deirdre Hahn  1 , Elisabeth M Hodson  2   3 , Jonathan C Craig  3   4
Affiliations
Review

Interventions for preventing and treating kidney disease in IgA vasculitis

Deirdre Hahn et al. Cochrane Database Syst Rev. .

Abstract

Background: IgA vasculitis (IgAV), previously known as Henoch-Schönlein purpura, is the most common vasculitis of childhood but may also occur in adults. This small vessel vasculitis is characterised by palpable purpura, abdominal pain, arthritis or arthralgia and kidney involvement. This is an update of a review first published in 2009 and updated in 2015.

Objectives: To evaluate the benefits and harms of different agents (used singularly or in combination) compared with placebo, no treatment or any other agent for (1) the prevention of severe kidney disease in people with IgAV with or without kidney involvement at onset, (2) the treatment of established severe kidney disease (macroscopic haematuria, proteinuria, nephritic syndrome, nephrotic syndrome with or without acute kidney failure) in IgAV, and (3) the prevention of recurrent episodes of IgAV-associated kidney disease.

Search methods: We searched the Cochrane Kidney and Transplant Register of Studies up to 2 February 2023 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) comparing interventions used to prevent or treat kidney disease in IgAV compared with placebo, no treatment or other agents were included.

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

Main results: Twenty studies (1963 enrolled participants) were identified; one three-arm study has been assessed as two studies. Nine studies were at low risk of bias for sequence generation (selection bias), and nine studies were at low risk of bias for allocation concealment (selection bias). Blinding of participants and personnel (performance bias) and outcome assessment (detection bias) was at low risk of bias in four and seven studies, respectively. Nine studies reported complete outcome data (attrition bias), while 10 studies reported expected outcomes, so were at low risk of reporting bias. Five studies were at low risk of other bias. Eleven studies evaluated therapy to prevent persistent kidney disease in IgAV with or without kidney involvement at presentation. There was probably no difference in the risk of persistent kidney disease any time after treatment (5 studies, 746 children: RR 0.74, 95% CI 0.42 to 1.32) or at one, three, six and 12 months in children given prednisone for 14 to 28 days at presentation of IgAV compared with placebo or supportive treatment (moderate certainty evidence). There may be no differences in the risk of any persistent kidney disease with antiplatelet therapy (three studies) or heparin (two studies) in children with or without any kidney disease at study entry, although heparin may reduce the risk of proteinuria by three months compared with placebo or no specific treatment (2 studies, 317 children: RR 0.47, 95% CI 0.31 to 0.73). One study comparing montelukast with placebo found no differences in outcomes as assessed by severity scale scores. Nine studies examined the treatment of severe IgAV-associated kidney disease. In two studies (one involving 56 children and the other involving 54 adults), there may be no differences in efficacy outcomes or adverse effects with cyclophosphamide compared with placebo or supportive treatment. In two studies, there may be no differences in the numbers achieving remission of proteinuria with intravenous (IV) cyclophosphamide compared with mycophenolate mofetil (MMF) (65 children evaluated) or tacrolimus (142 children evaluated). In three small studies comparing cyclosporin with methylprednisolone (15 children), MMF with azathioprine (26 children), or MMF with leflunomide (19 children), it is unclear whether the treatment had any effect on the numbers in remission or the degree of proteinuria between treatment groups because of small numbers of included participants. In one study comparing plasmapheresis, cyclophosphamide and methylprednisolone with cyclophosphamide and methylprednisolone, there may be no difference in the numbers achieving remission. One study compared fosinopril with no specific therapy and reported fosinopril reduced the number of participants with proteinuria. No studies were identified that evaluated the efficacy of therapy on kidney disease in participants with recurrent episodes of IgAV.

Authors' conclusions: There are no substantial changes in conclusions from this update compared with the initial review or the previous update despite the addition of five studies. From generally low to moderate certainty evidence, we found that there may be little or no benefit in the use of corticosteroids or antiplatelet agents to prevent persistent kidney disease in children with IgAV in participants with no or minimal kidney involvement at presentation. We did not find any studies which evaluated corticosteroids in children presenting with IgAV and nephritic and/or nephrotic syndrome, although corticosteroids are recommended in such children in guidelines. Though heparin may be effective in reducing proteinuria, this potentially dangerous therapy is not justified to prevent serious kidney disease when few children with IgAV develop severe kidney disease. There may be no benefit of cyclophosphamide compared with no specific treatment or corticosteroids. While there may be no benefit in the efficacy of MMF or tacrolimus compared with IV cyclophosphamide in children or adults with IgAV and severe kidney disease, adverse effects, particularly infections, may be lower in MMF or tacrolimus-treated children. Because of small patient numbers and events leading to imprecision in results, it remains unclear whether cyclosporin, MMF or leflunomide have any role in the treatment of children with IgAV and severe kidney disease. We did not identify any studies which evaluated corticosteroids.

Trial registration: ClinicalTrials.gov NCT00190229 NCT00425724 NCT02939573 NCT00301613 NCT02532777 NCT02532790 NCT02540720.

PubMed Disclaimer

Conflict of interest statement

  1. Deirdre Hahn: no relevant interests were disclosed

  2. Elisabeth Hodson: no relevant interests were disclosed

  3. Jonathan Craig: no relevant interests were disclosed

Figures

1
1
Flow diagram of study selection
2
2
Risk of bias: Review authors' judgements about each methodological quality item presented as percentages across all included studies.
3
3
Risk of bias: Review authors' judgements about each risk of bias item for each included study
1.1
1.1. Analysis
Comparison 1: Prednisone versus placebo/supportive treatment for preventing persistent kidney disease, Outcome 1: Persistent kidney disease at any time after treatment
1.2
1.2. Analysis
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
1.3
1.3. Analysis
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)
1.4
1.4. Analysis
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
1.5
1.5. Analysis
Comparison 1: Prednisone versus placebo/supportive treatment for preventing persistent kidney disease, Outcome 5: Number developing severe kidney disease
1.6
1.6. Analysis
Comparison 1: Prednisone versus placebo/supportive treatment for preventing persistent kidney disease, Outcome 6: Duration of kidney disease
1.7
1.7. Analysis
Comparison 1: Prednisone versus placebo/supportive treatment for preventing persistent kidney disease, Outcome 7: Gastrointestinal complications requiring hospital admission
1.8
1.8. Analysis
Comparison 1: Prednisone versus placebo/supportive treatment for preventing persistent kidney disease, Outcome 8: Eight‐year outcomes
2.1
2.1. Analysis
Comparison 2: Antiplatelet agents versus supportive treatment for preventing persistent kidney disease, Outcome 1: Kidney disease at any time
3.1
3.1. Analysis
Comparison 3: Heparin versus placebo for preventing persistent kidney disease, Outcome 1: Any kidney disease at 2 to 3 months after onset or relapse
3.2
3.2. Analysis
Comparison 3: Heparin versus placebo for preventing persistent kidney disease, Outcome 2: Type of kidney disease at 2 to 3 months or more after onset or relapse
3.3
3.3. Analysis
Comparison 3: Heparin versus placebo for preventing persistent kidney disease, Outcome 3: Time to development of kidney disease
4.1
4.1. Analysis
Comparison 4: Cyclophosphamide versus supportive treatment for treating severe kidney disease, Outcome 1: Persistent kidney disease
4.2
4.2. Analysis
Comparison 4: Cyclophosphamide versus supportive treatment for treating severe kidney disease, Outcome 2: Persistent severe kidney disease
4.3
4.3. Analysis
Comparison 4: Cyclophosphamide versus supportive treatment for treating severe kidney disease, Outcome 3: ESKD
5.1
5.1. Analysis
Comparison 5: Cyclophosphamide + steroids versus steroids for treating severe kidney disease, Outcome 1: Primary outcome: BVAS at 6 months
5.2
5.2. Analysis
Comparison 5: Cyclophosphamide + steroids versus steroids for treating severe kidney disease, Outcome 2: Secondary endpoints at 12 months
5.3
5.3. Analysis
Comparison 5: Cyclophosphamide + steroids versus steroids for treating severe kidney disease, Outcome 3: Adverse effects
6.1
6.1. Analysis
Comparison 6: Tacrolimus versus IV cyclophosphamide for treating severe kidney disease, Outcome 1: Number with resolution of proteinuria and haematuria at 2 years
6.2
6.2. Analysis
Comparison 6: Tacrolimus versus IV cyclophosphamide for treating severe kidney disease, Outcome 2: Number with recurrence of proteinuria and haematuria at 2 years
6.3
6.3. Analysis
Comparison 6: Tacrolimus versus IV cyclophosphamide for treating severe kidney disease, Outcome 3: Laboratory parameters
6.4
6.4. Analysis
Comparison 6: Tacrolimus versus IV cyclophosphamide for treating severe kidney disease, Outcome 4: Adverse effects
7.1
7.1. Analysis
Comparison 7: Cyclosporin versus methylprednisolone for treating severe kidney disease, Outcome 1: Number with remission at 3 months
7.2
7.2. Analysis
Comparison 7: Cyclosporin versus methylprednisolone for treating severe kidney disease, Outcome 2: Number with remission at last follow‐up (mean 6.3 years)
8.1
8.1. Analysis
Comparison 8: Mycophenolate mofetil versus IV cyclophosphamide for treating severe kidney disease, Outcome 1: Number with complete remission
8.2
8.2. Analysis
Comparison 8: Mycophenolate mofetil versus IV cyclophosphamide for treating severe kidney disease, Outcome 2: Number with complete or partial remission
8.3
8.3. Analysis
Comparison 8: Mycophenolate mofetil versus IV cyclophosphamide for treating severe kidney disease, Outcome 3: Adverse effects
9.1
9.1. Analysis
Comparison 9: Mycophenolate mofetil versus azathioprine for treating severe kidney disease, Outcome 1: Remission of proteinuria at 1 year
9.2
9.2. Analysis
Comparison 9: Mycophenolate mofetil versus azathioprine for treating severe kidney disease, Outcome 2: Regression of histological lesions at 1 year
9.3
9.3. Analysis
Comparison 9: Mycophenolate mofetil versus azathioprine for treating severe kidney disease, Outcome 3: Relapse of IgAV
9.4
9.4. Analysis
Comparison 9: Mycophenolate mofetil versus azathioprine for treating severe kidney disease, Outcome 4: Glomerular filtration rate
10.1
10.1. Analysis
Comparison 10: Mycophenolate mofetil versus leflunomide for treating severe kidney disease, Outcome 1: 24‐hour urine proteinuria
11.1
11.1. Analysis
Comparison 11: Double filtration plasmapheresis versus no plasmapheresis for treating severe kidney disease, Outcome 1: Remission
11.2
11.2. Analysis
Comparison 11: Double filtration plasmapheresis versus no plasmapheresis for treating severe kidney disease, Outcome 2: Adverse effects
12.1
12.1. Analysis
Comparison 12: Fosinopril + supportive treatment versus supportive treatment for treating proteinuria in IgAV, Outcome 1: Proteinuria
See this image and copyright information in PMC

Update of

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in this review

CESAR 2010 {published data only}
    1. Pillebout E, Alberti C, Guillevin L, Ouslimani A, Thervet E, CESAR study group. Addition of cyclophosphamide to steroids provides no benefit compared with steroids alone in treating adult patients with severe Henoch Schonlein Purpura. Kidney International 2010;78(5):495-502. [MEDLINE: ] - PubMed
    1. Pillebout E, Alberti C, Guillevin L, Thervet E, CESAR Study Group. Prospective randomized study of cyclophosphamide and steroid versus steroid alone therapy in adult patients with severe Henoch Schonlein Purpura (HSP) [abstract no: SA275]. In: World Congress of Nephrology; 2009 May 22-26; Milan, Italy. 2009. [CENTRAL: CN-01657237]
    1. Pillebout E, Alberti C, Guillevin L, Thervet E. Prospective randomized study of cyclophosphamide and steroid versus steroid alone therapy in adults patients with severe Henoch Schonlein Purpura (HSP)-CESAR study group [abstract no: TH-PO175]. Journal of the American Society of Nephrology 2009;20(Abstract Suppl):150A.
Du 2016 {published data only}
    1. Du Y, Zhang Z, Hou L, Qin K, Wang X, Wu Y. Comparison of Leflunomide and Mycophenolate mofetil in children with Henoch-Schonlein nephritis [abstract no: PO-163]. Pediatric Nephrology 2016;31(10):1817. [EMBASE: 612479523]
Dudley 2013 {published and unpublished data}ISRCTN71445600
    1. Dudley J, Smith G, Llewellyn-Edwards A, Tizard EJ. Randomised placebo controlled trial to assess the role of early prednisolone on the development and progression of Henoch-Schonlein Purpura Nephritis [abstract no: 270 (FC)]. Pediatric Nephrology 2007;22(9):1457. [CENTRAL: CN-00691227]
    1. Dudley J, Smith G, Llewelyn-Edwards A, Bayliss K, Pike K, Tizard J. Randomised, double-blind, placebo-controlled trial to determine whether steroids reduce the incidence and severity of nephropathy in Henoch-Schonlein Purpura (HSP). Archives of Disease in Childhood 2013;98(10):756-63. [MEDLINE: ] - PubMed
    1. Dudley J, Smith GC, Llewellyn-Edwards A, Tizard J. Randomised placebo controlled trial to assess the role of early prednisolone on the development and progression of Henoch-Schonlein Purpura nephritis [abstract no: SA-FC056]. Journal of the American Society of Nephrology 2007;18(Abstracts):47A. [CENTRAL: CN-01657243]
Fuentes 2010 {published data only}
    1. Endo JA, Enciso S, Fuentes-Velasco Y, Velasquez-Jones L, Hernandez AM, Valverde S, et al. Efficacy of mycophenolate mofetil and prednisone compared to azathioprine and prednisone treatment in children with Henoch-Shonlein purpura nephritis [abstract no: FP-S26-1]. Pediatric Nephrology 2016;31(10):1753-4. [EMBASE: 612479687]
    1. Fuentes Y, Valverde S, Hernandez AM, Ortiz LM, Medeiros M. Henoch-Schonlein Purpura nephritis: comparison of two therapies (azathioprine vs mycophenolate) and it's effect on the urinary excretion of MCP-1 [abstract no: FR-PO1921]. Journal of the American Society of Nephrology 2011;22(Abstract Suppl):558A.
    1. Fuentes Y, Valverde S, Velasquez-Jones L, Romero B, Ramón G, Medeiros M. Comparison of azathioprine vs mofetil mycophenolate for Henoch-Schonlein nephritis treatment [abstract no: 39]. Pediatric Nephrology 2010;25(9):1802. [CENTRAL: CN-01657240]
Geng 2021 {published data only}
    1. Geng HY, Chen CY, Li HR, Tu J, Du PW, Xia H. Efficacy and safety of mycophenolate mofetil versus cyclophosphamide in the treatment of Henoch-Schonlein purpura nephritis with nephrotic-range proteinuria in children: a prospective randomized controlled trial. Zhongguo Dangdai Erke Zazhi 2021;23(4):338-42. [MEDLINE: ] - PMC - PubMed
He 2002 {published data only}
    1. He YY, Hongmei S, Lihua S, Min W. Preventive value of heparin on the occurrence of nephropathy in Henoch-Schoenlein Purpura: a randomized controlled clinical trial [abstract no: 0364]. In: 23rd International Congress of Pediatrics; 2001 Sep 9-14; Beijing, China. 2001. [CENTRAL: CN-00462028]
    1. He YY, Pan W, Song HM, Wei M, Zhu CY. Preventive effect of heparin on the development of nephropathy in Henoch-Schoenlein purpura-a randomized controlled clinical trial. Chinese Journal of Pediatrics 2002;40(2):99-102. [CENTRAL: CN-01657239]
Huber 2004 {published data only}85109383
    1. Huber AM, King J, McLaine P, Klassen T, Pothos M. A randomized, placebo-controlled trial of prednisone in early Henoch Schonlein purpura [ISRCTN85109383]. BMC Medicine 2004;2:7. [MEDLINE: ] - PMC - PubMed
Islek 1999 {published data only}
    1. Islek I, Sezer T, Totan M, Cakir M, Kucukoduk S. The effect of profilactic prednisolon therapy on renal involvement in Henoch Schonlein vasculitis [abstract]. In: XXXVI Congress of the European Renal Association European Dialysis & Transplant Association; 1999 Sep 5-8; Madrid, Spain. 1999:103. [CENTRAL: CN-00484464]
Jauhola 2010 {published and unpublished data}
    1. Jauhola O, Ronkainen J, Ala-Houhala M, Autio-Harmainen H, Holtta T, Jahnukainen T, et al. Cyclosporine A (CyA) versus MP pulses (MP) in severe Henoch-Schoenlein nephritis (HSN): outcome after 2 year follow-up [abstract no: O05]. Pediatric Nephrology 2008;23(9):1584. [CENTRAL: CN-01657238]
    1. Jauhola O, Ronkainen J, Autio-Harmainen H, Koskimies O, Ala-Houhala M, Arikoski P, et al. Cyclosporine A vs. methylprednisolone for Henoch-Schonlein nephritis: a randomized trial [Erratum in: Pediatr Nephrol. 2011 Dec;26(12):2263-4]. Pediatric Nephrology 2011;26(12):2159-66. [MEDLINE: ] - PubMed
    1. Jauhola O, Ronkainen J, Koskimies O, Ala-Houhala M, Arikoski P, Holtta T, et al. Clinical course of extrarenal symptoms in Henoch-Schonlein purpura: a 6-month prospective study. Archives of Disease in Childhood 2010;95(11):871-6. [MEDLINE: ] - PubMed
    1. Jauhola O, Ronkainen J, Koskimies O, Ala-Houhala M, Arikoski P, Holtta T, et al. Renal manifestations of Henoch-Schonlein purpura in a 6-month prospective study of 223 children. Archives of Disease in Childhood 2010;95(11):877-82. [MEDLINE: ] - PubMed
    1. Ronkainen J, Ala-Houhala M, Antkainen M, Jahnukainen T, Koskimies O, Merenmies J, et al. Cyclosporine A (CyA) versus MP pulses (MP) in the treatment of severe Henoch-Schonlein Nephritis (HSN) [abstract no: COD. PP38]. Pediatric Nephrology 2006;21(10):1531. [CENTRAL: CN-00689778]
Liu 2019e {published data only}
    1. Liu N, Ma ZZ, Yan HF, Li Q, Lyu XQ, Kang WL, et al. Clinical effect of double filtration plasmapheresis combined with glucocorticoid and immunosuppressant in treatment of children with severe Henoch-Schonlein purpura nephritis. Zhongguo Dangdai Erke Zazhi 2019;21(10):955-9. [MEDLINE: ] - PMC - PubMed
Mollica 1992 {published data only}
    1. Mollica F, Li Volti S, Garozzo R, Russo G. Effectiveness of early prednisone treatment in preventing the development of nephropathy in anaphylactoid purpura. European Journal of Pediatrics 1992;151(2):140-4. [MEDLINE: ] - PubMed
Peratoner 1990 {published data only}
    1. Peratoner L, Longo F, Lepore L, Freschi P. Prophylaxis and therapy of glomerulonephritis in the course of anaphylactoid purpura. The results of a polycentric clinical trial. Acta Paediatrica Scandinavica 1990;79(10):976-7. [MEDLINE: ] - PubMed
Ronkainen 2006a {published and unpublished data}
    1. Jauhola O, Ronkainen J, Koskimies O, Ala-Houhala M, Arikoski P, Holtta T, et al. Clinical course of extrarenal symptoms in Henoch-Schonlein purpura: a 6-month prospective study. Archives of Disease in Childhood 2010;95(11):871-6. [MEDLINE: ] - PubMed
    1. Jauhola O, Ronkainen J, Koskimies O, Ala-Houhala M, Arikoski P, Holtta T, et al. Outcome of Henoch-Schoenlein purpura 8 years after the treatment with placebo or prednisone at disease onset [abstract no: PS2-FRI-493]. Pediatric Nephrology 2011;26(9):1678-9. - PubMed
    1. Jauhola O, Ronkainen J, Koskimies O, Ala-Houhala M, Arikoski P, Holtta T, et al. Outcome of Henoch-Schonlein purpura 8 years after treatment with a placebo or prednisone at disease onset. Pediatric Nephrology 2012;27(6):933-9. [MEDLINE: ] - PubMed
    1. Jauhola O, Ronkainen J, Koskimies O, Ala-Houhala M, Arikoski P, Holtta T, et al. Renal manifestations of Henoch-Schonlein purpura in a 6-month prospective study of 223 children. Archives of Disease in Childhood 2010;95(11):877-82. [MEDLINE: ] - PubMed
    1. Ronkainen J, Koskimies O, Ala-Houhala M, Antkainen M, Merenmies J, Rajantie J, et al. Early prednisone therapy in Henoch-Schonlein purpura: a randomized double-blind, placebo-controlled trial. Journal of Pediatrics 2006;149(2):241-7. [MEDLINE: ] - PubMed
Tarshish 2004 {published data only}
    1. Tarshish P, Bernstein J, Edelmann C. Henoch-Schonlein purpura (HSP) nephritis: efficacy of cytoxan (C) & natural history. Report of the ISKDC [abstract]. Pediatric Research 2001;49(4):421A. [CENTRAL: CN-00486109]
    1. Tarshish P, Bernstein J, Edelmann CM Jr. Henoch-Schonlein purpura nephritis: course of disease and efficacy of cyclophosphamide. Pediatric Nephrology 2004;19(1):51-6. [MEDLINE: ] - PubMed
Tian 2015 {published data only}
    1. Tian M, Liu C. Heparin calcium treated Henoch-Schonlein purpura nephritis in children through inhibiting hyperfibrinolysis. Renal Failure 2015;37(7):1100-4. [MEDLINE: ] - PubMed
Wu 2014c {published data only}
    1. Wu SH, Liao PY, Chen XQ, Yin PL, Dong L. Add-on therapy with montelukast in the treatment of Henoch-Schonlein purpura. Pediatrics International 2014;56(3):315-22. [MEDLINE: ] - PubMed
Xu 2009 {published data only}
    1. Xu J, Cong H, Sheng Y. Efficacy of fosinopril on proteinuria in children with Henoch-Schonlein purpura nephritis. Zhongguo Dangdai Erke Zazhi 2009;11(3):229-30. [MEDLINE: ] - PubMed
Yoshimoto 1987a {published data only}
    1. Yoshimoto M, Ito H, Shindo S, Yamashita F. Evaluation of the preventive role of dipyridamole and aspirin against renal complication in Schonlein-Henoch purpura [abstract]. Pediatric Nephrology 1987;1:C47. [CENTRAL: CN-00445875]
Yoshimoto 1987b {published data only}
    1. Yoshimoto M, Ito H, Shindo S, Yamashita F. Evaluation of the preventive role of dipyridamole and aspirin against renal complication in Schonlein-Henoch purpura [abstract]. Pediatric Nephrology 1987;1:C47. [CENTRAL: CN-00445875]
Zhang 2021a {published data only}
    1. Zhang H, Li X, Xu H, Ran F, Zhao G. Effect and safety evaluation of tacrolimus and tripterygium glycosides combined therapy in treatment of Henoch-Schonlein purpura nephritis. International Journal of Urology 2021;28(11):1157-63. [MEDLINE: ] - PubMed

References to studies excluded from this review

Chen 2010 {published data only}
    1. Chen T, Guo ZP, Zhang YH, Gao Y. Effect of MORA bioresonance therapy in the treatment of Henoch-Schonlein purpura and influence on serum antioxidant enzymes. Journal of Clinical Dermatology 2010;39(5):283-5. [EMBASE: 359206443]
ChiCTR2100050353 {published data only}
    1. ChiCTR2100050353. Efficacy and side effects of different doses of Tripterygium Wilfordii granules combined with traditional Chinese medicine in the treatment of children with recurrent Henoch-Schonlein Purpura. https://trialsearch.who.int/Trial2.aspx?TrialID=ChiCTR2100050353 (first received 26 August 2021). [CENTRAL: CN-02450623]
ChiCTR‐INR‐17013850 {published data only}
    1. ChiCTR-INR-17013850. Effects of laminar flow bed on Henoch-Schonlein Purpura in children. www.chictr.org.cn/showproj.aspx?proj=20982 (first received 11 December 2017).
Cui 2020 {published data only}
    1. Cui Y, Li J, Zhang J, Han T, Gao L, Wang H, et al. Efficacy of Yupingfeng San for assisting in treatment of children with Henoch-Schonlein purpura and its effects on oxidative stress and the immune system. International Journal of Clinical & Experimental Medicine 2020;13(1):293-9. [EMBASE: 2003657269]
Ding 1995 {published data only}
    1. Ding HL, Cheng JZ. Clinical trial of potenlin in allergic purpura of adults. Journal of Clinical Dermatology 1995;24(5):300-2. [CENTRAL: CN-00550728]
Ding 2014 {published data only}
    1. Ding D, Yan H, Zhen X. Effects of Chinese herbs in children with Henoch-Schonlein purpura nephritis: a randomized controlled trial. Journal of Traditional Chinese Medicine 2014;34(1):15-22. [MEDLINE: ] - PubMed
Ding 2019 {published data only}
    1. Ding Y, Zhang X, Ren X, Zhai W, He L, Liu J, et al. Traditional Chinese medicine versus regular therapy in Henoch-Schonlein purpura nephritis in children: study protocol for a randomized controlled trial. Trials [Electronic Resource] 2019;20(1):538. [MEDLINE: ] - PMC - PubMed
Ding 2021 {published data only}
    1. Ding Y, Li XJ, Zhang X, Han SS, Xu SS, Dai YL, et al. Clinical study on different dosage of Tripterygium wilfordii Granules combined with Purpura No. I prescription in treating children with recurrent Henoch-Schonlein purpura. Chinese Traditional & Herbal Drugs 2021;52(24):7569-76. [EMBASE: 2016021484]
Erdogan 1999 {published data only}
    1. Erdogan O, Oner A, Aydin A, Isimer A, Demircin G, Bulbul M, et al. Lack of efficacy of vitamin e supplementation in decreasing the oxidative damage Henoch-Schonlein Purpura: a randomised controlled trial [abstract]. Nephrology Dialysis Transplantation 1999;14(9):A46. [CENTRAL: CN-00483878]
Fu 2021 {published data only}
    1. Fu Q, Shi MF, Chen Y. Clinical effect of alfacalcidol in children with Henoch-Schonlein purpura: a prospective randomized controlled trial. Zhongguo Dangdai Erke Zazhi 2021;23(8):797-801. [MEDLINE: ] - PMC - PubMed
Fukui 1989 {published data only}
    1. Fukui H, Kamitsuji H, Nagao T, Yamada K, Akatsuka J, Inagaki M, et al. Clinical evaluation of a pasteurized factor XIII concentrate administration in Henoch-Schönlein purpura. Japanese Pediatric Group. Thrombosis Research 1989;56(6):667-75. [CENTRAL: CN-00067042] - PubMed
Gao 2018a {published data only}
    1. Gao X, Miao R, Tao Y, Chen X, Wan C, Jia R. Effect of montmorillonite powder on intestinal mucosal barrier in children with abdominal Henoch-Schonlein Purpura: a randomized controlled study. Medicine 2018;97(39):e12577. [MEDLINE: ] - PMC - PubMed
Hui‐Lan 2001 {published data only}
    1. Hui-Lan Y. Treatment of pediatric purpuric nephritis with Tripterygium wilfordii polyglucoside and radix salviac miltiorrhizae [abstract no: P85]. Pediatric Nephrology 2001;16(8):C79. [CENTRAL: CN-00445801]
    1. Hui-Lan YY. Treatment of purpuric nephritis in children with Tripterygium wilfordii polyglucoside and Radix salviae miltiorrhizae [abstract no: P79]. Pediatric Nephrology 2001;16(8):C78. [CENTRAL: CN-00445799]
Jia 2001 {published data only}
    1. Jia WC, Zhang YC, Wei AP. Immune functional changes in patients of acute Henoch-Schonlein purpura and regulatory effect of integrated Traditional Chinese and Western medicine on it. Zhongguo Zhongxiyi Jiehe Zazhi [Chinese Journal of Integrated Traditional & Western Medicine] 2001;21(8):585-7. [MEDLINE: ] - PubMed
Jiang 2003 {published data only}
    1. Jiang Y. Therapeutic effect of low-dose hepacarin in the childhood anaphylactoid purpura. Journal of Pediatric Pharmacy 2003;9(4):58-9. [CENTRAL: CN-00583752]
Jin 2003 {published data only}
    1. Jin ZD, Wang SC, Sun YQ. Effect of Danshao granule on serum superoxide dismutase activity and malonyldialdehyde content in children with Henoch-Schonlein purpura nephritis. Zhongguo Zhongxiyi Jiehe Zazhi [Chinese Journal of Integrated Traditional & Western Medicine] 2003;23(12):905-7. [MEDLINE: ] - PubMed
Jin 2021 {published data only}
    1. Jin Y, Wang Y, Wang S, Zhao Q, Zhang D, Feng X. The efficacy of Tripterygium glycosides combined with LMWH in treatment of HSPN in children. Evidence-based Complementary & Alternative Medicine: eCAM 2021:7223613. [MEDLINE: ] - PMC - PubMed
Kim 1987 {published data only}
    1. Kim PK, Jeong HJ, Kim KS, Lee JK, Lee JS, Choi IJ. Rifampin therapy in Henoch-Schonlein Purpura nephritis accompanied by the nephrotic syndrome [abstract]. In: 10th International Congress of Nephrology; 1987 Jul 26-31; London, UK. 1987:18. [CENTRAL: CN-01657236]
Li 2022 {published data only}
    1. Li C, Wang ZB. Clinical application of compound Glycyrrhizin tablets in the treatment of patients with simplex Henoch-Schonlein Purpura and its effect on immune function. Pakistan Journal of Medical Sciences 2022;38(1):271-5. [MEDLINE: ] - PMC - PubMed
Liu 2004a {published data only}
    1. Liu CS, Gong ZZ, Xiang SH. Clinical study on integrative Chinese and Western medicine in treating allergic purpura and preventing renal impairment. Zhongguo Zhongxiyi Jiehe Zazhi [Chinese Journal of Integrated Traditional & Western Medicine] 2004;24(8):701-3. [MEDLINE: ] - PubMed
Liu 2008 {published data only}
    1. Liu QC, Wu WH, Wu DY, Feng XW, Ma YH, Li JY, et al. Clinical observation on the treatment of childhood refractory idiopathic thrombocytopenic purpura with Dihuang Zhixue capsule. Chinese Journal of Integrative Medicine 2008;14(2):132-6. [MEDLINE: ] - PubMed
NCT02939573 {published data only}
    1. Micheletti R, Pagnoux C. A randomized multicenter study for isolated skin vasculitis (ARAMIS). clinicaltrials.gov/show/NCT02939573 (first received 20 October 2016).
NCT03647852 {published data only}
    1. Sun L, Huang W. Clinical study on strategy for refractory Henoch-Schönlein Purpura. clinicaltrials.gov/show/NCT03647852 (first received 27 August 2018).
NCT04008316 {published data only}
    1. Pillebout E. Efficacy of colchicine to prevent skin relapses in adult's IgA vasculitis (COLCHIVAS). clinicaltrials.gov/show/NCT04008316 (first received 5 July 2019).
Shao 2021 {published data only}
    1. Shao KF, Guan FJ, Dong C. Clinical effect and mechanism of total glucosides of paeony in the adjuvant therapy for children with Henoch-Schonlein purpura nephritis: a prospective randomized controlled study. Zhongguo Dangdai Erke Zazhi [Chinese Journal of Contemporary Pediatrics] 2021;23(1):49-54. [MEDLINE: ] - PMC - PubMed
Wang 2011 {published data only}
    1. Wang ZW, Lu Y, Zhen XF. Effect of herbs in early intervention of children with Henoch-Schonlein purpura nephritis. Zhongguo Zhongxiyi Jiehe Zazhi [Chinese Journal of Integrated Traditional & Western Medicine] 2011;31(4):504-7. [MEDLINE: ] - PubMed
Wang 2021a {published data only}
    1. Wang L, Yin C, Zhang M, Mao H, Hao H, Hu X, et al. A randomized controlled trial on the effect of dietary guidance on the treatment of Henoch-Schonlein purpura in children. Journal of Investigative Medicine 2021;69(8):1464-72. [MEDLINE: ] - PubMed
Wu 2013b {published data only}
    1. Wu L, Mao J, Jin X, Fu H, Shen H, Wang J, et al. Efficacy of triptolide for children with moderately severe Henoch-Schonlein purpura nephritis presenting with nephrotic range proteinuria: a prospective and controlled study in China. BioMed Research International 2013;2013:292865. [MEDLINE: ] - PMC - PubMed
Xia 2016 {published data only}
    1. Xia LP, Chen X, Jiang Y. Clinical effect of gamma globulin pulse therapy for abdominal Henoch-Schonlein purpura in children. Zhongguo Dangdai Erke Zazhi 2016;18(10):988-90. [MEDLINE: ] - PMC - PubMed
Xie 2009 {published data only}
    1. Xie XL, Kou SR, Xu YH, Li CY. Effect of composite salvia injection on platelet parameters in children with anaphylactoid purpura. Chinese Journal of Integrative Medicine 2009;15(2):149-51. [MEDLINE: ] - PubMed
Xiong 2019 {published data only}
    1. Xiong LJ, Shang LH, Ou XQ, Li Y, Xie XL. Clinical effect of alanyl-glutamine-enriched nutritional support in the treatment of children with abdominal Henoch-Schonlein purpura. Zhongguo Dangdai Erke Zazhi 2019;21(2):168-71. [MEDLINE: ] - PMC - PubMed
Yang 2010 {published data only}
    1. Yang HJ, Zhuang KS, Bu TW, Mu LQ. Controlled study on therapeutic effect of vessel pricking therapy and western medication for treatment of Henoch-Schonlein purpura nephritis. Zhongguo Zhenjiu 2010;30(6):449-52. [MEDLINE: ] - PubMed
Yi 2007 {published data only}
    1. Yi H. Effect of Shenyankangfu tablet on urinary IL-6 and its therapeutic effect in children with Henoch-Schonlein purpura nephritis. Zhongguo Dangdai Erke Zazhi 2007;9(2):153-4. [MEDLINE: ] - PubMed
Zhang 1984 {published data only}
    1. Zhang WZ, Zhou MJ. Clinical observation of anisodamine on treatment of anaphylactoid purpura by infused intravenously. Chinese Journal of Practical Internal Medicine 1984;4(1):26. [CENTRAL: CN-00583439]
Zhang 2019b {published data only}
    1. Zhang X, Jiang D, Liu R, Fang G, Guo Z. Therapeutic effect of Vitamin D on Henoch-Schonlein purpura in children and its influence on immune mechanism. Pharmaceutical Care & Research 2019;19(3):192-5. [EMBASE: 628873404]
Zhao 2009 {published data only}
    1. Zhao H, Dou ZY, Li YQ. Preventive effect of integrative medical therapy on children Henoch-Schonleln purpura with renal impairment. Zhongguo Zhongxiyi Jiehe Zazhi [Chinese Journal of Integrated Traditional & Western Medicine] 2009;29(4):351-3. [MEDLINE: ] - PubMed
Zhu 2016 {published data only}
    1. Zhu TF, Chu ZF, Li JH. Effect of tripterygium glycosides and Danshen injection on blood coagulation mechanism in children with allergic purpura nephritis. Zhongguo Zhongyao Zazhi [China Journal of Chinese Materia Medica] 2016;41(11):2162-7. [MEDLINE: ] - PubMed

References to studies awaiting assessment

NCT00301613 {published data only}
    1. Liu ZH. Mycophenolate mofetil (MMF) versus intravenous CTX pulses in the treatment of adult severe HSPN. www.clinicaltrials.gov/ct2/show/NCT00301613 (first received 13 March 2006).

References to ongoing studies

NCT02532777 {published data only}
    1. Zhang A. The research of standard diagnosis and treatment for HSPN in children [The research of standard diagnosis and treatment for Henoch-Schonlein Purpura nephritis in children]. clinicalTrials.gov/show/NCT02532777 (first received 26 August 2015).
NCT02532790 {published data only}
    1. Zhang A. The research of standard diagnosis and treatment for HSPN with mild proteinuria in children [The research of standard diagnosis and treatment for Henoch-Schonlein Purpura nephritis with mild proteinuria in children]. clinicalTrials.gov/show/NCT02532790 (first received 26 August 2015).
NCT02540720 {published data only}
    1. Zhang A. The research of standard diagnosis and treatment for severe HSP in children [The research of standard diagnosis and treatment for severe Henoch-Schonlein Purpura in children]. ClinicalTrials.gov/show/NCT02540720 (first received 4 September 2015).

Additional references

Bergstein 1998
    1. Bergstein J, Leiser J, Andreoli SP. Response of crescentic Henoch-Schoenlein purpura nephritis to corticosteroid and azathioprine therapy. Clinical Nephrology 1998;49(1):9-14. [MEDLINE: ] - PubMed
Davin 2011
    1. Davin JC. Henoch-Schonlein purpura nephritis: pathophysiology, treatment and future strategy. Clinical Journal of The American Society of Nephrology: CJASN 2011;6(3):679-89. [MEDLINE: ] - PubMed
Delbert 2021
    1. Delbert JD, Parmentier C, Herbez Rea C, Mouche A, Ulinksi T. Management of IgA vasculitis with nephritis. Pediatric Drugs 2021;23(5):425-35. [MEDLINE: ] - PubMed
Du 2012
    1. Du Y, Hou L, Zhao C, Han W, Wu Y. Treatment of children with Henoch-Schonlein purpura nephritis with mycophenolate mofetil. Pediatric Nephrology 2012;27(5):765-71. [MEDLINE: ] - PubMed
Flynn 2001
    1. Flynn JT, Smoyer WE, Bunchman TE, Kershaw DB, Sedman AB. Treatment of Henoch-Schonlein Purpura glomerulonephritis in children with high-dose corticosteroids plus oral cyclophosphamide. American Journal of Nephrology 2001;21(2):128-33. [MEDLINE: ] - PubMed
Foster 2000
    1. Foster BJ, Bernard C, Drummond KN, Sharma AK. Effective therapy for severe Henoch-Schonlein purpura nephritis with prednisone and azathioprine: a clinical and histopathologic study. Journal of Pediatrics 2000;136(3):370-5. [MEDLINE: ] - PubMed
Goldstein 1992
    1. Goldstein AR, White RH, Akuse R, Chantler C. Long-term follow-up of childhood Henoch Schonlein nephritis. Lancet 1992;339(8788):280-2. [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
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 2022
    1. Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al. Cochrane Handbook for Systematic Reviews of Interventions version 6.3 (updated February 2022). Cochrane, 2022. Available from www.training.cochrane.org/handbook.
Iijima 1998
    1. Iijima R, Ito-Kariya S, Nakamura H, Yoshikowa N. Multiple combined therapy for severe Henoch Schonlein nephritis in children. Pediatric Nephrology 1998;12(3):244-8. [MEDLINE: ] - PubMed
Jennette 2013
    1. Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis & Rheumatism 2013;65(1):1-11. [MEDLINE: ] - PubMed
Kawasaki 2004
    1. Kawasaki Y, Suzuki J, Suzuki H. Efficacy of methylprednisolone and urokinase pulse therapy combined with or without cyclophosphamide in severe Henoch-Schoenlein nephritis: a clinical and histopathological study. Nephrology Dialysis Transplantation 2004;19(4):858-64. [MEDLINE: ] - PubMed
KDIGO 2021
    1. Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group. KDIGO 2021 Clinical practice guideline for the management of glomerular diseases. Kidney International 2021;100(4S):S115-27. [MEDLINE: ] - PubMed
Narchi 2005
    1. Narchi H. Risk of long term renal impairment and duration of follow up recommended for Henoch-Schonlein purpura with normal or minimal urinary findings: a systematic review. Archives of Disease in Childhood 2005;90(9):916-20. [MEDLINE: ] - PMC - PubMed
Niaudet 1998
    1. Niaudet P, Habib R. Methylprednisolone pulse therapy in the treatment of severe forms of Schonlein-Henoch purpura nephritis. Pediatric Nephrology 1998;12(3):238-43. [MEDLINE: ] - PubMed
Ozen 2019
    1. Ozen S, Marks SD, Brogan P, Groot N, Graeff N, Avcin T, et al. European consensus-based recommendations for diagnosis and treatment of immunoglobulin A vasculitis-the SHARE initiative. Rheumatology 2019;58(9):1607-16. [MEDLINE: ] - PubMed
Piram 2017
    1. Piram M, Maldini C, Biscardi S, De Suremain N, Orzechowski C, Georget E, et al. Incidence of IgA vasculitis in children estimated by four-source capture-recapture analysis: a population-based study. Rheumatology 2017;56(8):1358-66. [MEDLINE: ] - PubMed
Ronkainen 2003
    1. Ronkainen J, Ala-Houhala M, Huttunen NP, Jahnukainen T, Koskimies O, Ormala T, et al. Outcome of Henoch-Schoenlein nephritis with nephrotic-range proteinuria. Clinical Nephrology 2003;60(2):80-4. [MEDLINE: ] - PubMed
Ruperto 2010
    1. Ruperto N, Ozen S, Pistorio A, Dolezalova P, Brogan P, Cabral DA, et al. EULAR/PRINTO/PRES criteria for Henoch-Schonlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part I: overall methodology and clinical characterisation [Erratum in: Ann Rheum Dis. 2011 Feb;70(2):397 Note: Paut, Isabelle Kone [corrected to Kone-Paut, Isabella]]. Annals of the Rheumatic Diseases 2010;69(5):790–7. [MEDLINE: ] - PubMed
Saulsbury 1999
    1. Saulsbury FT. Henoch-Schonlein Purpura in children. Report of 100 patients and review of the literature. Medicine 1999;78(6):395-409. [MEDLINE: ] - PubMed
Schulz 1995
    1. Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 1995;273(5):408-12. [MEDLINE: ] - PubMed
Schunemann 2022a
    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 JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.3 (updated February 2022). Cochrane, 2022. www.training.cochrane.org/handbook.
Schunemann 2022b
    1. Schünemann HJ, Vist GE, Higgins JP, Santesso N, Deeks JJ, Glasziou P, et al. Chapter 15: Interpreting results and drawing conclusions. In: Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.3 (updated February 2022). Cochrane, 2022. Available from www.training.cochrane.org/handbook.
Shenoy 2007
    1. Shenoy M, Ognjanovic MV, Coulthard MG. Treating severe Henoch-Schonlein and IgA nephritis with plasmapheresis alone. Pediatric Nephrology 2007;22(8):1167-71. [MEDLINE: ] - PubMed
Shin 2006
    1. Shin JI, Park JM, Shin YH, Hwang DH, Kim JH, Lee JS. Predictive factors for nephritis, relapse, and significant proteinuria in childhood Henoch-Schonlein purpura. Scandinavian Journal of Rheumatology 2006;35(1):56-60. [MEDLINE: ] - PubMed
Weiss 2007
    1. Weiss PF, Feinstein JA, Luan X, Burnham JM, Feudtner C. Effects of corticosteroid on Henoch-Schonlein purpura: a systematic review. Pediatrics 2007;120(5):1079-87. [MEDLINE: ] - PMC - PubMed
Wood 2008
    1. Wood L, Egger M, Gluud LL, Schulz KF, Juni P, Altman DG, et al. Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes: meta-epidemiological study. BMJ 2008;336(7644):601-5. [MEDLINE: ] - PMC - PubMed
Wyatt 2001
    1. Wyatt RJ, Hogg RJ. Evidence-based assessment of treatment options for children with IgA nephropathies. Pediatric Nephrology 2001;16(2):156-67. [MEDLINE: ] - PubMed
Zaffanello 2007
    1. Zaffanello M, Brugnara M, Franchini M. Therapy for children with Henoch-Schonlein Purpura nephritis: a systematic review. Thescientificworldjournal 2007;7:20-30. [MEDLINE: ] - PMC - PubMed

References to other published versions of this review

Chartapisak 2005
    1. Chartapisak W, Opastirakul S, Hodson EM, Willis NS, Craig JC. Interventions for preventing and treating renal disease in Henoch-Schönlein Purpura (HSP). Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No: CD005128. [DOI: 10.1002/14651858.CD005128] - DOI - PubMed
Chartapisak 2008
    1. Chartapisak W, Opastirakul O, Willis NS, Craig JC, Hodson EM. Prevention and treatment of renal disease in Henoch-Schönlein Purpura: a systematic review. Archives of Disease in Childhood 2008;94(2):132-7. [MEDLINE: ] - PubMed
Chartapisak 2009
    1. Chartapisak W, Opastirakul S, Hodson EM, Willis NS, Craig JC. Interventions for preventing and treating kidney disease in Henoch-Schönlein Purpura (HSP). Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No: CD005128. [DOI: 10.1002/14651858.CD005128.pub2] - DOI - PubMed
Hahn 2015
    1. Hahn D, Hodson EM, Willis NS, Craig JC. Interventions for preventing and treatment of kidney disease in Henoch-Schönlein Purpura (HSP). Cochrane Database of Systematic Reviews 2015, Issue 8. Art. No: CD005128. [DOI: 10.1002/14651858.CD005128.pub3] - DOI - PMC - PubMed

Associated data