Pediatric Nephrology

, Volume 18, Issue 9, pp 906–912 | Cite as

Interventions for steroid-resistant nephrotic syndrome: a systematic review

  • Doaa Habashy
  • Elisabeth M. Hodson
  • Jonathan C. Craig
Original Article


In a systematic review and meta-analysis of randomized controlled trials (RCT), we aimed to evaluate the benefits and harms of all interventions for children with steroid-resistant nephrotic syndrome (SRNS). Nine RCTs involving 225 children were included. Cyclosporin when compared with placebo or no treatment significantly increased the number of children who achieved complete remission [3 trials, 49 children, relative risk (RR) for persistent nephrotic syndrome 0.64, 95% confidence intervals (CI), 0.47–0.88]. There was no significant difference in the number of children who achieved complete remission between oral cyclophosphamide with prednisone and prednisone alone [2 trials, 91 children, RR 1.01, 95% CI 0.74–1.36], between intravenous cyclophosphamide and oral cyclophosphamide [1 study, 11 children, RR 0.09, 95% CI 0.01–1.39], and between azathioprine with prednisone and prednisone alone [1 trial, 31 children, RR 1.01, 95% CI 0.77–1.32]. No RCTs were identified comparing combination regimens comprising high-dose steroids, alkylating agents or cyclosporin with single agents, placebo, or no treatment. Further adequately powered and well-designed RCTs are needed to confirm the efficacy of cyclosporin and to evaluate regimens of high-dose steroids with alkylating agents or cyclosporin for SRNS.


Steroid-resistant nephrotic syndrome Meta-analysis Corticosteroids Immunosuppressive agents Angiotensin-converting enzyme inhibitors 



This work was presented at the Annual Scientific Meeting of the Australian and New Zealand Society of Nephrology, Sydney, Australia, 2–4 September 2002 and published in abstract form in Nephrology 2002. Dr. Craig and Dr. Hodson are supported by the National Health and Medical Research Council of Australia and the Federal Department of Health and Aged Care of Australia. The authors would like to thank Dr. Arvind Bagga for providing additional trial data. The authors wish to thank Mrs. Narelle Willis, Review Group Co-ordinator of the Cochrane Renal Group, and Mrs. Ruth Mitchell, Trials Search Co-ordinator of the Cochrane Renal Group, for their help with this study, which was carried out for the Cochrane Collaboration.


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Copyright information

© IPNA 2003

Authors and Affiliations

  • Doaa Habashy
    • 1
  • Elisabeth M. Hodson
    • 1
    • 3
  • Jonathan C. Craig
    • 1
    • 2
  1. 1.Center for Kidney Research and Cochrane Renal Group, NHMRC Center for Clinical Research ExcellenceThe Children's Hospital at WestmeadSydneyAustralia
  2. 2.School of Public HealthUniversity of SydneySydneyAustralia
  3. 3.Center for Kidney ResearchThe Children's Hospital at WestmeadWestmeadAustralia

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