Effect of corticosteroid on preventing renal impairment in children with Henoch Schnlein purpura: a meta-analysis of randomized controlled trials

Objective To investigate whether early corticosteriod administration can reduce the rate of renal complications in children with Henoch Schnlein purpura (HSP). Methods Cochrane library, Medline, EMBASE, CNKI, VIP and Wanfang database were searched for the randomized controlled trials (RCTs) about the effect of corticosteriod administration on preventing renal disease in pediatric HSP published from January 1990 to June 2012. All included RCTs were graded in term of randomization, allocation concealment and blinding independently by two authors.The useful data were retrieved and summarized by two authors. RevMan 4.3 software was used for meta-analysis and the corresponding effect model was selected based on heterogeneity test. Descriptive method was used to analyze and summarize the data when meta-analysis was not achievable. Moreover, the sensitivity analysis was performed if nessccary. Results Five RCTs and one quasi-RCT were included, four of them discribed the specific randomized method and adopted adequate allocation concealment and blinding, and all of them reported loss of follow-up and retrievement.Four studies had low risk of bias,while two had high risk of bias. The results showed that the incidence of renal complication in treatment group and control group was 22.2%(42/189) and 26.3%(50/190) respectively (pooled relative risk:0.67, 95%CI:0.17-2.62) within six months, and the incidence was 10.9%(41/373) and 12.6%(46/364) respectively (pooled relative risk :0.85,95%CI:0.44-1.64) over six months, none of them was significant(P=0.57 and 0.65 respectively). In sensitivity analysis, two trials with high risk of bias were excluded to remove heterogeneity among studies and the same result was found as above. Conclusions There was no sufficient evidence showing that corticosteroid administration could siginificantly reduce the rate of complications in children with HSP. The results suggested that pediatricians should cautiously use corticosteroid ,or use it with anti-coagulation,anti-anaphylacty therapy according to specific clinical and experimental inspections.