Interventions for preventing and treating renal disease in Henoch Schönlein Purpura: a systematic review of randomised controlled trials.

Wattana Chartapisak1,2, Sauwalak Opastirakul1, Narelle Willis2, Elisabeth Hodson2,3, Jonathan Craig 2,3
1. Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand 50200
2. Cochrane Renal Group, Centre for Kidney Research, The Children Hospital at Westmead, Westmead, Sydney, NSW 2145 3. School of Public Health, University of Sydney

Henoch Schönlein Purpura (HSP) is a primary small vessel vasculitis. Approximately one third of children develop renal involvement with 1.5% progressing to chronic renal failure. We conducted a systemic review of randomised controlled trials to examine the benefits and harms of different interventions for preventing or treating renal disease in HSP. Using standard comprehensive search methods, we identified 7 eligible trials. Results were expressed as relative risk (RR) with 95% confidence intervals (CI) and where appropriate data were combined in meta-analyses using a random effects model. In prevention trials, there was no significant difference in the risk of haematuria and proteinuria between corticosteroids and placebo/no intervention (3 trials, 328 children; RR 0.62; 95% CI 0.18-2.18) but there was considerable heterogeneity between trials. No benefit of dipyridamole, cyproheptadine and aspirin compared with no treatment could be demonstrated (2 trials; 101 patients; RR 1.16; 95% CI 0.46-2.95). In a single trial with few methodological details published in abstract only, heparin reduced the risk of renal involvement compared with no treatment (228 patients; RR 0.27; 95% CI 0.14-0.55). No prevention trial reported on harms. In a single treatment trial, there was no significant difference in the risk for persistent severe renal disease with cyclophosphamide compared with no treatment (56 children; RR 0.88; 95% CI 0.37-2.09). Few trial data are available to assess interventions for renal disease in HSP. Data are not available from randomised controlled trials to support the use of any agents to prevent or treat renal involvement in HSP.

Presented at the Australian & New Zealand Society of Nephrology [ANZSN]. 42nd Annual Meeting. Melbourne , 16-18 Aug 2006