ISN-Cochrane Webinar: Interventions for preventing and treating kidney disease in IgA vasculitis

IgA vasculitis (IgAV) is the most common vasculitis of childhood and may manifest with glomerulonephritis. This is an updated Cochrane systematic review of randomised controlled trials in IgAV.

Twenty studies (1963 participants) were identified. Most studies were at high or unclear risk of bias for most methodological domains. For the prevention of kidney disease, there were no differences with prednisone (5 studies) antiplatelets (3 studies) or heparin (2 studies) in children. For the treatment of severe kidney disease, there were no differences in efficacy outcomes or adverse effects with cyclophosphamide compared with placebo or supportive treatment (2 studies) in children or adults.

 Learning objectives:

- Understand the benefits and harms of different treatments for the prevention or treatment of kidney disease in people with IgAV with or without kidney involvement at onset
- Understand how the findings of this review contribute to the enhancement of clinical management strategies for IgA Vasculitis (IgAV).
- Analyze and interpret the implications derived from the review's findings, fostering a comprehension of their impact on shaping the direction of future research endeavors in IgAV.

Further reading: 

- 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: 34556256]
- Ozen_S, Marks_SD, Brogan_P, Groot_N, de_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: 30879080]
- 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: 34396492]
- Zaffanello_M, Brugnara_M, Franchini_M. Therapy for children with Henoch-Schonlein Purpura nephritis: a systematic review. The Scientific World Journal 2007;7:20-30. [MEDLINE: 17221139]
- 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: 17974746]
- 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: 23845696]
- 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: 20505654]
- 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: 34378238]