What do systematic reviews say?

Mycophenolate sodium + oral steroids vs oral steroids alone

Mycophenolate sodium + oral steroids showed no clear difference in adverse events: death compared with oral steroids alone (low certainty).

• Interventions for minimal change disease in adults with nephrotic syndrome 2022 · Cochrane Headline outcomes only
  RR 0.67 [0.12, 3.84]
  1 study · 116 participants
  Low

Intermittent oral vs oral calcitriol

• Interventions for bone disease in children with chronic kidney disease 2010 · Cochrane Headline outcomes only
  no estimate extracted
  2 studies · 80 participants
  Moderate

Intravenous ± oral steroids vs oral steroids alone

It is very uncertain whether intravenous ± oral steroids changes adverse events: thromboses compared with oral steroids alone (very low certainty).

• Interventions for minimal change disease in adults with nephrotic syndrome 2022 · Cochrane Headline outcomes only
  RR 0.5 [0.05, 4.75]
  1 study · 22 participants
  Very low

Intermittent oral vs oral calcitriol

• Interventions for bone disease in children with chronic kidney disease 2010 · Cochrane Headline outcomes only
  no estimate extracted
  1 study · 59 participants
  Low

Intravenous ± oral steroids vs oral steroids alone

It is very uncertain whether intravenous ± oral steroids changes adverse events: gastrointestinal bleeding compared with oral steroids alone (very low certainty).

• Interventions for minimal change disease in adults with nephrotic syndrome 2022 · Cochrane Headline outcomes only
  RR 0.13 [0.15, 0.4]
  1 study · 18 participants
  Very low

Mycophenolate sodium + oral steroids vs oral steroids alone

Mycophenolate sodium + oral steroids showed no clear difference in adverse events: acute kidney injury compared with oral steroids alone (low certainty).

• Interventions for minimal change disease in adults with nephrotic syndrome 2022 · Cochrane Headline outcomes only
  RR 0.5 [0.05, 5.36]
  1 study · 116 participants
  Low

Calcineurin inhibitors ± oral steroids vs oral steroids alone

Calcineurin inhibitors ± oral steroids showed no clear difference in adverse events: acute kidney injury compared with oral steroids alone (low certainty).

• Interventions for minimal change disease in adults with nephrotic syndrome 2022 · Cochrane Headline outcomes only
  RR 1.78 [0.35, 8.99]
  4 studies · 270 participants
  Low

Mycophenolate sodium + oral steroids vs oral steroids alone

Mycophenolate sodium + oral steroids showed no clear difference in adverse events: new‐onset glucose intolerance compared with oral steroids alone (low certainty).

• Interventions for minimal change disease in adults with nephrotic syndrome 2022 · Cochrane Headline outcomes only
  RR 0.2 [0.01, 4.08]
  2 studies · 136 participants
  Low

Oral cyclophosphamide vs prednisone or placebo

Oral cyclophosphamide showed no clear difference in adverse events: death (all causes) compared with prednisone or placebo (low certainty).

• Interventions for idiopathic steroid‐resistant nephrotic syndrome in children 2019 · Cochrane Headline outcomes only
  RR 1.07 [0.19, 5.95]
  1 study · 60 participants
  Low

Oral cyclophosphamide vs prednisone or placebo

It is very uncertain whether oral cyclophosphamide changes adverse events: hypertension with seizures compared with prednisone or placebo (very low certainty).

• Interventions for idiopathic steroid‐resistant nephrotic syndrome in children 2019 · Cochrane Headline outcomes only
  RR 0.71 [0.05, 10.89]
  1 study · 60 participants
  Very low

Oral alkylating agents ± steroids vs steroids or placebo or both, or no treatment

It is very uncertain whether oral alkylating agents ± steroids changes adverse events ‐ malignancy at final compared with placebo/no treatment/steroids (very low certainty).

• Immunosuppressive treatment for primary membranous nephropathy in adults with nephrotic syndrome 2021 · Cochrane Headline outcomes only
  RR 1.63 [0.21, 12.37]
  2 studies · 199 participants
  Very low

Oral alkylating agents ± steroids vs steroids or placebo or both, or no treatment

It is very uncertain whether oral alkylating agents ± steroids changes adverse events ‐ infection at 3 years compared with placebo/no treatment/steroids (very low certainty).

• Immunosuppressive treatment for primary membranous nephropathy in adults with nephrotic syndrome 2021 · Cochrane Headline outcomes only
  RR 1.68 [0.3, 9.45]
  1 study · 70 participants
  Very low

Oral alkylating agents ± steroids vs steroids or placebo or both, or no treatment

Oral alkylating agents ± steroids may leads to higher adverse events ‐ temporary/permanent discontinuation or… compared with placebo/no treatment/steroids (low certainty).

• Immunosuppressive treatment for primary membranous nephropathy in adults with nephrotic syndrome 2021 · Cochrane Headline outcomes only
  RR 1.44
  3 studies · 184 participants
  Low

IV vs oral cyclophosphamide

It is very uncertain whether IV changes adverse events: vomiting compared with oral cyclophosphamide (very low certainty).

• Interventions for idiopathic steroid‐resistant nephrotic syndrome in children 2019 · Cochrane Headline outcomes only
  RR 2.38 [0.35, 16.17]
  2 studies · 61 participants
  Very low

IV vs oral cyclophosphamide

IV showed no clear difference in adverse events: alopecia compared with oral cyclophosphamide (low certainty).

• Interventions for idiopathic steroid‐resistant nephrotic syndrome in children 2019 · Cochrane Headline outcomes only
  RR 1.5 [0.27, 8.22]
  1 study · 50 participants
  Low

Intravenous vs oral cyclophosphamide

Intravenous showed no clear difference in adverse events: hair loss compared with oral cyclophosphamide (low certainty).

• Non‐corticosteroid immunosuppressive medications for steroid‐sensitive nephrotic syndrome in children 2020 · Cochrane Headline outcomes only
  RR 0.19 [0.04, 1.03]
  2 studies · 83 participants
  Low

Intravenous vs oral cyclophosphamide

Intravenous showed no clear difference in adverse events: leucopenia compared with oral cyclophosphamide (low certainty).

• Non‐corticosteroid immunosuppressive medications for steroid‐sensitive nephrotic syndrome in children 2020 · Cochrane Headline outcomes only
  RR 0.37 [0.09, 1.51]
  2 studies · 83 participants
  Low

IV cyclophosphamide vs IV dexamethasone and oral cyclophosphamide

IV cyclophosphamide may leads to lower adverse events: hypertension compared with oral cyclophosphamide plus IV dexamethasone (low certainty).

• Interventions for idiopathic steroid‐resistant nephrotic syndrome in children 2019 · Cochrane Headline outcomes only
  RR 0.04 [0, 0.68]
  1 study · 49 participants
  Low

Intravenous vs oral cyclophosphamide

Intravenous may leads to lower adverse events: all infections compared with oral cyclophosphamide (low certainty).

• Non‐corticosteroid immunosuppressive medications for steroid‐sensitive nephrotic syndrome in children 2020 · Cochrane Headline outcomes only
  RR 0.14 [0.03, 0.72]
  2 studies · 83 participants
  Low

Intravenous vs oral cyclophosphamide

It is very uncertain whether intravenous changes adverse events: nausea and vomiting compared with oral cyclophosphamide (very low certainty).

• Non‐corticosteroid immunosuppressive medications for steroid‐sensitive nephrotic syndrome in children 2020 · Cochrane Headline outcomes only
  RR 4.07 [0.21, 80.51]
  1 study · 47 participants
  Very low