Cochrane · systematic review · CD003594
Interventions for idiopathic steroid‐resistant nephrotic syndrome in children
Liu, ID, Willis, NS, Craig, JC, et al. · Cochrane Database of Systematic Reviews · 2019 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
62
current version
GRADE rated
62
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 0 · 0%Very low 14 · 22.6%Low 42 · 67.7%Moderate 6 · 9.7%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Show all 3 versionsCyclosporin versus placebo or no treatment for idiopathic steroid‐resistant nephrotic syndrome in children
Population: idiopathic steroid‐resistant nephrotic syndrome in children
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Complete remission: all renal pathologies Cyclosporin vs placebo or no treatment | RR 3.5 [1.09, 11.2] | 4 studies · 74 participants | Low Downgraded: risk of bias |
Complete remission: FSGS Cyclosporin vs placebo or no treatment | RR 3.14 [0.97, 10.18] | 3 studies · 58 participants | Low Downgraded: risk of bias |
Complete or partial remission: all renal pathologies Cyclosporin vs placebo or no treatment | RR 3.15 [1.04, 9.57] | 4 studies · 74 participants | Low Downgraded: risk of bias |
Complete or partial remission: FSGS Cyclosporin vs placebo or no treatment | RR 2.66 [0.85, 8.31] | 2 studies · 49 participants | Low Downgraded: risk of bias |
Adverse events: worsening of hypertension Cyclosporin vs placebo or no treatment | RR 1 [0.17, 5.98] | 1 study · 24 participants | Very low Downgraded: risk of bias |
Adverse events: infection Cyclosporin vs placebo or no treatment | RR 0.7 [0.2, 2.51] | 1 study · 17 participants | Very low Downgraded: risk of bias |
Adverse events: ESKD Cyclosporin vs placebo or no treatment | RR 0.23 [0.03, 1.79] | 1 study · 25 participants | Very low Downgraded: risk of bias |
Calcineurin inhibitor versus IV cyclophosphamide for idiopathic steroid‐resistant nephrotic syndrome in children
Population: idiopathic steroid‐resistant nephrotic syndrome in children
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Treatment response at 3 to 6 months: complete or partial remission Calcineurin inhibitor vs IV cyclophosphamide | RR 1.98 [1.25, 3.13] | 2 studies · 156 participants | Low Downgraded: risk of bias, imprecision |
Treatment response at 3 to 6 months: complete remission Calcineurin inhibitor vs IV cyclophosphamide | RR 3.43 [1.84, 6.41] | 2 studies · 156 participants | Low Downgraded: risk of bias, imprecision |
Treatment response at 3 to 6 months: partial remission Calcineurin inhibitor vs IV cyclophosphamide | RR 1.68 [0.43, 6.56] | 2 studies · 156 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events: treatment failure at 6 months (non response, serious infection, persistently elevated creatinine) Calcineurin inhibitor vs IV cyclophosphamide | RR 0.32 [0.18, 0.58] | 1 study · 124 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Adverse events: medications ceased due to adverse events Calcineurin inhibitor vs IV cyclophosphamide | RR 0.2 [0.04, 0.86] | 1 study · 131 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Adverse events: serious infections Calcineurin inhibitor vs IV cyclophosphamide | RR 0.49 [0.16, 1.56] | 1 study · 131 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Adverse events: death Calcineurin inhibitor vs IV cyclophosphamide | RR 0.33 [0.01, 7.92] | 1 study · 131 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Tacrolimus versus cyclosporin for idiopathic steroid‐resistant nephrotic syndrome in children
Population: idiopathic steroid‐resistant nephrotic syndrome in children
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Treatment response at 6 months: complete remission Tacrolimus vs cyclosporin | RR 1.14 [0.64, 2.03] | 1 study · 41 participants | Low |
Treatment response at 6 months: complete and partial remission Tacrolimus vs cyclosporin | RR 0.57 [0.16, 2.08] | 1 study · 41 participants | Low |
Treatment response at 12 months: complete remission Tacrolimus vs cyclosporin | RR 0.8 [0.45, 1.42] | 2 studies · 58 participants | Low Downgraded: risk of bias, imprecision |
Treatment response at 12 months: complete and partial remission Tacrolimus vs cyclosporin | RR 1.05 [0.87, 1.25] | 2 studies · 58 participants | Low Downgraded: risk of bias, imprecision |
Adverse events: persistent nephrotoxicity Tacrolimus vs cyclosporin | RR 0.48 [0.05, 4.85] | 1 study · 41 participants | Low |
Adverse events: worsening of hypertension Tacrolimus vs cyclosporin | no estimate extracted | 2 studies · 58 participants | Low Downgraded: risk of bias, imprecision |
Cyclosporin versus mycophenolate mofetil with pulse dexamethasone for idiopathic steroid‐resistant nephrotic syndrome in children
Population: idiopathic steroid‐resistant nephrotic syndrome in children
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Treatment response at 52 weeks: complete remission (primary outcome 1, 2) Cyclosporin vs mycophenolate mofetil with pulse dexamethasone | RR 2.14 [0.87, 5.24] | 1 study · 138 participants | Moderate |
Treatment response at 52 weeks: partial remission (primary outcome 3) Cyclosporin vs mycophenolate mofetil with pulse dexamethasone | RR 1.09 [0.61, 1.93] | 1 study · 138 participants | Moderate |
Sustainable remission between 52 and 78 weeks: complete or partial remission (primary outcome 1, 2, 3) Cyclosporin vs mycophenolate mofetil with pulse dexamethasone | RR 1.38 [0.9, 2.1] | 1 study · 138 participants | Moderate |
CKD or death: death by 52 weeks Cyclosporin vs mycophenolate mofetil with pulse dexamethasone | RR 0.18 [0.01, 3.75] | 1 study · 138 participants | Low |
CKD or death: 50% decline in GFR by 78 weeks Cyclosporin vs mycophenolate mofetil with pulse dexamethasone | RR 2.29 [0.46, 11.41] | 1 study · 138 participants | Low |
Adverse events (weeks 0 to 26): serious infection requiring hospitalisation Cyclosporin vs mycophenolate mofetil with pulse dexamethasone | RR 0.65 [0.22, 1.96] | 1 study · 138 participants | Low |
Adverse events (weeks 0 to 26): hypertension Cyclosporin vs mycophenolate mofetil with pulse dexamethasone | RR 1.68 [0.66, 4.29] | 1 study · 138 participants | Low |
Tacrolimus versus mycophenolate mofetil to maintain remission for idiopathic steroid‐resistant nephrotic syndrome in children
Population: idiopathic steroid‐resistant nephrotic syndrome in children
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Number with complete or partial response at one year Tacrolimus vs mycophenolate mofetil to maintain remission | RR 2.01 [1.32, 3.07] | 1 study · 60 participants | Low Downgraded: risk of bias |
Number with complete response at one year Tacrolimus vs mycophenolate mofetil to maintain remission | RR 1.79 [1.11, 2.9] | 1 study · 60 participants | Low Downgraded: risk of bias |
Number with partial response at one year Tacrolimus vs mycophenolate mofetil to maintain remission | RR 4.68 [0.58, 37.68] | 1 study · 60 participants | Low Downgraded: risk of bias |
Number with treatment failure by one year Tacrolimus vs mycophenolate mofetil to maintain remission | RR 0.18 [0.06, 0.54] | 1 study · 60 participants | Low Downgraded: risk of bias |
Number with frequent relapses by one year Tacrolimus vs mycophenolate mofetil to maintain remission | RR 0.28 [0.09, 0.92] | 1 study · 60 participants | Low Downgraded: risk of bias |
Number with steroid resistance by one year Tacrolimus vs mycophenolate mofetil to maintain remission | RR 0.07 [0, 1.23] | 1 study · 60 participants | Low Downgraded: risk of bias |
Change in GFR Tacrolimus vs mycophenolate mofetil to maintain remission | no estimate extracted | 1 study · 60 participants | Low Downgraded: risk of bias |
Oral cyclophosphamide versus prednisone or placebo for idiopathic steroid‐resistant nephrotic syndrome in children
Population: idiopathic steroid‐resistant nephrotic syndrome in children
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Complete remission: all renal pathologies Oral cyclophosphamide vs prednisone or placebo | RR 1.06 [0.61, 1.87] | 2 studies · 84 participants | Low Downgraded: risk of bias |
Complete remission: FSGS Oral cyclophosphamide vs prednisone or placebo | RR 1.01 [0.43, 2.37] | 2 studies · 63 participants | Low Downgraded: risk of bias |
Complete or partial remission Oral cyclophosphamide vs prednisone or placebo | RR 0.88 [0.53, 1.45] | 1 study · 53 participants | Low Downgraded: risk of bias |
Complete or partial remission: FSGS Oral cyclophosphamide vs prednisone or placebo | RR 0.88 [0.53, 1.45] | 1 study · 53 participants | Low Downgraded: risk of bias |
Treatment failure Oral cyclophosphamide vs prednisone or placebo | RR 1.59 [0.87, 2.88] | 1 study · 60 participants | Low Downgraded: risk of bias |
Adverse events: death (all causes) Oral cyclophosphamide vs prednisone or placebo | RR 1.07 [0.19, 5.95] | 1 study · 60 participants | Low Downgraded: risk of bias |
Adverse events: hypertension with seizures Oral cyclophosphamide vs prednisone or placebo | RR 0.71 [0.05, 10.89] | 1 study · 60 participants | Very low Downgraded: risk of bias |
IV versus oral cyclophosphamide for idiopathic steroid‐resistant nephrotic syndrome in children
Population: idiopathic steroid‐resistant nephrotic syndrome in children
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Complete remission IV vs oral cyclophosphamide | RR 1.58 [0.65, 3.85] | 2 studies · 61 participants | Low Downgraded: risk of bias, imprecision |
Partial remission IV vs oral cyclophosphamide | RR 1 [0.15, 6.55] | 1 study · 50 participants | Low Downgraded: risk of bias, imprecision |
Continuing remission at one year IV vs oral cyclophosphamide | RR 0.75 [0.19, 3.01] | 1 study · 50 participants | Low Downgraded: risk of bias, imprecision |
Adverse events: renal insufficiency IV vs oral cyclophosphamide | RR 0.33 [0.04, 2.99] | 1 study · 50 participants | Low Downgraded: risk of bias, imprecision |
Adverse events: bacterial infection IV vs oral cyclophosphamide | RR 1.02 [0.1, 10.62] | 2 studies · 61 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events: vomiting IV vs oral cyclophosphamide | RR 2.38 [0.35, 16.17] | 2 studies · 61 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events: alopecia IV vs oral cyclophosphamide | RR 1.5 [0.27, 8.22] | 1 study · 50 participants | Low Downgraded: risk of bias, imprecision |
IV cyclophosphamide versus oral cyclophosphamide plus IV dexamethasone for idiopathic steroid‐resistant nephrotic syndrome in children
Population: idiopathic steroid‐resistant nephrotic syndrome in children
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Treatment response at 6 months: complete remission IV cyclophosphamide vs oral cyclophosphamide plus IV dexamethasone | RR 1.13 [0.65, 1.96] | 1 study · 49 participants | Low Downgraded: imprecision |
Treatment response at 6 months: partial remission IV cyclophosphamide vs oral cyclophosphamide plus IV dexamethasone | RR 0.88 [0.14, 5.79] | 1 study · 49 participants | Low Downgraded: imprecision |
Treatment response at 6 months: complete or partial remission IV cyclophosphamide vs oral cyclophosphamide plus IV dexamethasone | RR 1.09 [0.68, 1.74] | 1 study · 49 participants | Low Downgraded: imprecision |
Treatment response at 18 months: sustained remission/steroid‐sensitive relapses IV cyclophosphamide vs oral cyclophosphamide plus IV dexamethasone | RR 1.13 [0.65, 1.96] | 1 study · 49 participants | Low Downgraded: imprecision |
Treatment response at 18 months: CKD IV cyclophosphamide vs oral cyclophosphamide plus IV dexamethasone | RR 0.88 [0.06, 13.35] | 1 study · 49 participants | Low Downgraded: imprecision |
Adverse events: hypertension IV cyclophosphamide vs oral cyclophosphamide plus IV dexamethasone | RR 0.04 [0, 0.68] | 1 study · 49 participants | Low Downgraded: imprecision |
Adverse events: bacterial infections IV cyclophosphamide vs oral cyclophosphamide plus IV dexamethasone | RR 0.66 [0.27, 1.63] | 1 study · 49 participants | Low Downgraded: imprecision |
Rituximab/cyclosporin/prednisolone versus cyclosporin/prednisolone for idiopathic steroid‐resistant nephrotic syndrome in children
Population: idiopathic steroid‐resistant nephrotic syndrome in children
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Number with complete remission: complete remission in initial steroid resistance Rituximab/cyclosporin/prednisolone vs cyclosporin/prednisolone | no estimate extracted | 1 study · 16 participants | Very low Downgraded: risk of bias |
Number with complete remission: complete remission in delayed steroid resistance Rituximab/cyclosporin/prednisolone vs cyclosporin/prednisolone | RR 1.14 [0.33, 3.94] | 1 study · 15 participants | Very low Downgraded: risk of bias |
Number with complete remission: complete remission in all patients Rituximab/cyclosporin/prednisolone vs cyclosporin/prednisolone | RR 0.94 [0.22, 3.94] | 1 study · 31 participants | Very low Downgraded: risk of bias |
Adverse events: bronchospasm/treatment discontinued Rituximab/cyclosporin/prednisolone vs cyclosporin/prednisolone | RR 2.82 [0.12, 64.39] | 1 study · 31 participants | Very low Downgraded: risk of bias |
Adverse events: hypotension Rituximab/cyclosporin/prednisolone vs cyclosporin/prednisolone | RR 2.82 [0.12, 64.39] | 1 study · 31 participants | Very low Downgraded: risk of bias |
Adverse events: skin rash Rituximab/cyclosporin/prednisolone vs cyclosporin/prednisolone | RR 6.59 [0.37, 117.77] | 1 study · 31 participants | Very low Downgraded: risk of bias |
Adverse events: mild dyspnoea Rituximab/cyclosporin/prednisolone vs cyclosporin/prednisolone | RR 4.71 [0.24, 90.69] | 1 study · 31 participants | Very low Downgraded: risk of bias |