Interventions for preventing and treating kidney disease in IgA vasculitis

Area of Science:

• Nephrology
• Rheumatology
• Pediatrics

Background:

• IgA vasculitis (IgAV), formerly Henoch-Schönlein purpura, is the most common childhood vasculitis, affecting small vessels and characterized by purpura, abdominal pain, arthritis, and kidney involvement.
• This review is an update of previous analyses, first published in 2009 and updated in 2015, examining current evidence on IgAV treatments.

Purpose of the Study:

• To assess the benefits and harms of various agents for preventing severe kidney disease in IgAV.
• To evaluate treatments for established severe kidney disease in IgAV.
• To determine the efficacy of therapies in preventing recurrent IgAV-associated kidney disease.

Main Methods:

• A systematic review of randomized controlled trials (RCTs) was conducted, searching the Cochrane Kidney and Transplant Register of Studies.
• Eligibility criteria included RCTs comparing interventions against placebo, no treatment, or other agents for kidney disease in IgAV.
• Data were extracted independently by two authors, with statistical analyses performed using random-effects models and evidence certainty assessed by GRADE.

Main Results:

• Low to moderate certainty evidence suggests corticosteroids and antiplatelet agents offer little to no benefit in preventing persistent kidney disease in children with IgAV and minimal kidney involvement.
• Heparin may reduce proteinuria but is not recommended due to potential risks, as severe kidney disease is uncommon in IgAV.
• Evidence for cyclophosphamide, mycophenolate mofetil (MMF), and tacrolimus in severe IgAV kidney disease is inconclusive, though MMF and tacrolimus may have fewer adverse effects than cyclophosphamide.

Conclusions:

• Current evidence indicates limited benefit from corticosteroids or antiplatelet agents for preventing kidney disease in IgAV, particularly in children with mild presentations.
• The efficacy of immunosuppressants like MMF and tacrolimus for severe IgAV kidney disease requires further investigation, with potential advantages in safety profiles over cyclophosphamide.
• There is a lack of studies evaluating treatments for recurrent IgAV-associated kidney disease, highlighting a significant gap in the evidence base.