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Author Manuscript
Pediatrics. Author manuscript; available in PMC 2012 December 18.
Published in final edited form as:
Pediatrics. 2007 November ; 120(5): 1079–1087. doi:10.1542/peds.2007-0667.

Effects of Corticosteroid on Henoch-Schönlein Purpura: A

Systematic Review
Pamela F. Weiss, MDa,b,c, James A. Feinstein, MDc, Xianqun Luan, MSd, Jon M. Burnham,
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MD, MSCEa,b,c, and Chris Feudtner, MD, PhD, MPHb,c,e

aDivision of Rheumatology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania

bCenterfor Clinical Epidemiology and Biostatistics, University of Pennsylvania School of

Medicine, Philadelphia, Pennsylvania
cPediatricGeneralist Research Group, Division of General Pediatrics, Children’s Hospital of
Philadelphia, Philadelphia, Pennsylvania
dDivision of Biostatistics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
eLeonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia,
Pennsylvania
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Abstract
OBJECTIVE—No consensus exists among general pediatricians or pediatric rheumatologists
regarding whether corticosteroid therapy ameliorates the acute manifestations of Henoch-
Schönlein purpura or mitigates renal injury. Therefore, we sought to synthesize the reported
experimental and observational data regarding corticosteroid use.
METHODS—We performed a meta-analysis based on a comprehensive review of the literature in
the Medline database (1956 to January 2007) and the Cochrane Controlled Trials Register. On the
basis of reported outcomes among patients with Henoch-Schönlein purpura who were treated at
diagnosis with corticosteroids compared with patients treated with supportive care only, we
calculated odds ratios for the resolution of abdominal pain, the need for surgical intervention
secondary to severe pain or intussusception, the likelihood of Henoch-Schönlein purpura
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recurrence, and the development of transient or persistent renal disease.

RESULTS—Of 201 articles retrieved from the initial literature search, 15 were eligible for
inclusion. Corticosteroid treatment did not reduce the median time to resolution of abdominal pain
but did significantly reduce the mean resolution time and increased the odds of resolution within
24 hours. Early corticosteroid treatment significantly reduced the odds of developing persistent
renal disease. In addition, although the results were not statistically significant, the prospective
data suggest reduced odds of both surgical intervention and recurrence.
CONCLUSIONS—Corticosteroids, given early in the course of illness, seem to produce
consistent benefits for several major clinically relevant Henoch-Schönlein purpura outcomes.

Keywords
Henoch-Schönlein purpura; corticosteroids; children; meta-analytic methods; systematic reviews

Copyright © 2007 by the American Academy of Pediatrics. All rights reserved.

Address correspondence to Pamela F. Weiss, MD, Division of Rheumatology, Children’s Hospital of Philadelphia, Children’s
Seashore House Room 236, 34th and Civic Center Boulevard, Philadelphia, PA 19104-4399. [email protected]..
The authors have indicated they have no financial relationships relevant to this article to disclose.
 Weiss et al. Page 2

Henoch-schönlein purpura (hsp) is the most common vasculitis of childhood, affecting

between 8 and 20 per 100 000 children annually and accounting for 49% of all childhood
vasculitides in the United States.1,2 Although typically self-limited, HSP can cause
gastrointestinal hemorrhage, intussusception, and end-stage renal disease (ESRD). Renal
involvement, manifested by hematuria, proteinuria, nephrotic syndrome, or renal
insufficiency, may occur in 60% of children.3 In 1 recent study, 54% of patients developed
renal manifestations within 3 months of diagnosis, 11.6% had persistent abnormalities after
7 years, and none developed ESRD.4 However, previous studies have reported that as much
as 21% of children with HSP-associated nephritis develop rapidly progressive
glomerulonephritis5; 15% of these children with HSP-associated rapidly progressive
glomerulonephritis, which is to say 2% of all patients with HSP, may progress to have
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uremia or ESRD.6 Furthermore, even seemingly benign HSP may have long-lasting effects:
2 studies have reported that 40% and 70% of term pregnancies of women with a history of
childhood-onset HSP were complicated by hypertension, proteinuria, or preeclampsia.7,8

The goals of treating HSP are typically to (1) ameliorate acute symptoms, (2) mitigate short-
term morbidity (such as abdominal complications that require surgery), and (3) prevent
chronic renal insufficiency. Because HSP is characterized by leukocyte infiltration of the
blood vessel walls along with immunoglobulin A deposition (with resulting vascular injury
and necrosis), and because corticosteroids inhibit inflammatory processes, early treatment
with corticosteroids has been postulated to be effective for all 3 therapeutic goals, but much
controversy remains.9-13 Although the literature is replete with retrospective studies that
evaluated corticosteroid use for HSP, currently there are only 3 published prospective,
placebo-controlled studies on the subject, and they vary in their conclusions regarding the
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utility of early corticosteroid administration.9,11,14

Through a systematic review and meta-analysis, we sought to compare and contrast the
experimental and observational data regarding corticosteroid use and, where appropriate,
synthesize the data for 5 main clinical questions: (1) Do corticosteroids shorten the duration
of abdominal symptoms in HSP? (2) Do corticosteroids decrease the odds of surgical
intervention for HSP? (3) Do corticosteroids decrease the odds of disease recurrence? (4) Do
corticosteroids decrease the odds of renal disease (transient plus persistent) in HSP? and (5)
Do corticosteroids decrease the odds of developing persistent renal disease in HSP?

METHODS
Data Sources
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The published medical literature was searched by using the Cochrane Controlled Trials
Register (CCTR) and Medline database. Articles written in all languages were included in
the search, and translation was obtained when needed.

CCTR and Medline were searched by using the Medical Subject Headings (MeSH) terms
“steroids,” “methylprednisolone,” and “dexamethasone” and the key words “Henoch” and
“corticosteroids.” “Henoch” and “purpura, Schönlein-Henoch” were grouped together and
joined by “or.” “Steroids,” “methylprednisolone,” “dexamethasone,” and “corticosteroids”
were grouped together and joined by “or.” Both groups of terms were joined together by
“and.” The only limit applied to the search was “all children: 0-18 years.”

Given the large number of studies obtained from the literature search (N = 201), we cite in
this report only the studies that were chosen for inclusion. A full list of publications is
available at www.pediatric-generalists.org/weiss.htm.

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Study Eligibility
Eligible studies were limited to those that examined the use of corticosteroids for the
treatment of HSP; observational and randomized, controlled trials were included. An article
was excluded if it (1) was a review, (2) examined therapy with a drug other than
corticosteroids, (3) was a case report with fewer than 5 subjects with HSP, (4) focused on
individuals older than 18 years, (5) did not discuss therapy with corticosteroids, (6) included
only patients with nephritis at study onset, (7) did not assess definite outcomes, or (8) did
not discuss HSP.

Study Selection
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The initial literature search of the CCTR and Medline databases yielded 201 articles in 14
languages. Titles were reviewed to screen for eligibility. If the title yielded insufficient data
to determine if a study was eligible, the abstract was obtained and reviewed. Articles
without sufficient information in the abstract or those without an accessible abstract were
examined in full text. Interpreters who were familiar with medical language and study
designs evaluated all articles written in languages other than English.

Two of the authors (Drs Weiss and Feinstein) independently screened each of the potential
titles, abstracts, and articles to determine inclusion. Disagreements were resolved by
discussion and consensus mediated by a third author (Dr Feudtner). Reasons for article
exclusion are presented in Table 1. After all the exclusions were applied, 15 articles
remained for further analysis (Table 2).
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In an attempt to find all relevant articles, the reference lists of included articles were
searched and yielded 2 additional articles for potential inclusion.15,16 However, neither
article was included because the outcomes could not be abstracted. In addition, the authors
of the included articles were contacted to learn of any unpublished trials or studies.

Data Extraction
Two authors (Drs Weiss and Feinstein) independently abstracted data from the remaining
articles. Disagreements were resolved by discussion and consensus mediated by a third
author (Dr Feudtner). Abstracted data from the remaining articles included information
regarding the study population, existence of a control group, study limitations, and
information relating to the resolution of abdominal pain, surgical intervention, recurrence,
and the incidence of renal sequelae.
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Statistical Analyses
Pooled odds ratios (ORs) were obtained by using the “metan” command for Stata 9.2 (Stata
Corp, College Station, TX) for each of 5 clinical outcomes: (1) resolution of abdominal
pain; (2) surgical intervention for severe abdominal pain or intussusception; (3) recurrence;
(4) cumulative renal abnormalities; and (5) persistent renal abnormalities. The odds of
having each outcome in patients who were treated with corticosteroids was compared with
patients treated with routine supportive care for both prospective and retrospective studies.
Results from fixed-effects models are reported. Tests for heterogeneity were performed for
each analysis as a way to evaluate to what extent the results were consistent and suitable for
fixed-effect modeling. If the test for heterogeneity was significant, we did not calculate a
pooled OR. The Egger test for bias was performed and funnel plots were performed for each
of the clinical outcomes to evaluate for publication bias. Each of the funnel plots was
symmetrical, which suggests the absence of publication bias. The Egger test for bias could
only be applied to analyses with 2 or more studies.

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RESULTS
Do Corticosteroids Shorten the Duration of Abdominal Symptoms in HSP?
Although there is no consensus regarding the indication for corticosteroid use in HSP,
anecdotally, abdominal pain is the most common reason that corticosteroids are prescribed.
Huber et al11 and Ronkainen et al9 prospectively evaluated the effect of corticosteroids on
abdominal pain duration by using 14-day symptom diaries. Huber et al11 used 2 mg/kg per
day of corticosteroids for 1 week, with weaning over week 2, whereas Ronkainen et al9 used
1 mg/kg per day of corticosteroids for 2 weeks, with weaning over weeks 3 and 4 (Table 2).
Using median values of total abdominal pain duration, Huber et al did not find any
difference between the treatment and control groups (P = .8) (Fig 1A). In contrast,
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Ronkainen et al found a mean reduction of 1.2 days of pain in patients who were treated
with corticosteroids (P = .03) (Fig 1A). Three retrospective studies reported on such effects
within the first 24 hours after corticosteroid administration.17-19 However, after analysis,
there was evidence of heterogeneity among the included studies (P = .015). A likely source
of heterogeneity was the timing of corticosteroid administration in relation to disease onset.
In the study by Reinehr et al18 31 of 57 patients received corticosteroids >21 days after the
onset of HSP, whereas in the other 2 studies the treatment group received corticosteroids
within several days of diagnosis. Analysis excluding the study by Reinehr et al showed a
statistically significant positive corticosteroid effect, and there was no significant
heterogeneity (OR: 5.42; 95% confidence interval [CI]: 1.60–18.29; P = .476) (Fig 1B).

A study by Chao et al20 looked at a unique group of patients with HSP who had
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hepatobiliary involvement. Involvement was defined by elevated liver transaminase levels

and abnormal abdominal ultrasound results. Of those treated with corticosteroids, 90% with
hepatic involvement, 100% with cholecystitis, and 100% with gallbladder sludge recovered
within 7 days. In contrast, in the untreated group, 25% with hepatic involvement, none of
those with cholecystitis, and only 50% with gallbladder sludge had resolution within 7 days.
All patients in both groups, however, had resolution of symptoms by 14 days.

Do Corticosteroids Decrease the Incidence of Surgical Intervention for HSP?

Only 3 studies (1 randomized, controlled trial and 2 observational trials) reported
intussusception, a rare and potentially life-threatening abdominal complication during the
acute phase of HSP.11,18,19 Huber et al11 provided the only prospective study that reported
incidence of intussusception; the risk of intussusception was reduced, but not to a significant
degree, in the group that received corticosteroids (OR: 0.16; 95% CI: 0.01–3.62). The 2
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retrospective studies together suggest a protective effect of corticosteroid exposure (OR:

0.75; 95% CI: 0.13–4.46) (Fig 2). There was no evidence of heterogeneity between the
studies (P = .39).

Does Early Treatment With Corticosteroids Decrease the Odds of HSP Recurrence?
Recurrences affect up to one third of children with HSP.13,21 Many of these children require
additional hospital admissions and pharmacotherapy. The 2 prospective studies with
recurrence data suggest a protective effect of corticosteroids (OR: 0.32; 95% CI: 0.07–1.49),
and there was no significant heterogeneity (P = .70) (Fig 3).11,14 The 5 retrospective
observational studies that examined HSP recurrence exhibited heterogeneity (P < .01), so a
pooled OR is not reported.11,13,14,20-23 The ORs and 95% CIs are reported for each study
(Fig 3). No evidence of publication bias was found (Egger test: P = .55).

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Do Corticosteroids Decrease the Likelihood of Developing Cumulative Renal

Abnormalities With HSP?
Eight studies have reported data on cumulative (transient or persistent) renal abnormalities
during the year after diagnosis.9-14,17,24 Heterogeneity was present among both the
prospective and retrospective studies (P = .03 and P < .01, respectively), so pooled ORs are
not reported. Instead, the individual ORs and 95% CIs of each study, prospective and
retrospective, are shown (Fig 4). No evidence of publication bias was found (Egger test: P
= .59 and .66 for the prospective and retrospective studies, respectively).

Do Corticosteroids Decrease the Likelihood of Developing Persistent Renal

Abnormalities?
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In the 3 prospective studies, early corticosteroid treatment significantly reduced the odds of
developing persistent renal disease (OR: 0.43; 95% CI: 0.19–0.96) (Fig 5A).8,10,13 There
was no evidence of marked heterogeneity among the studies (P = .341). In addition, no
evidence of publication bias was found (Egger test: P = .99). The retrospective study by
Saulsbury12 did not show a statistically significant difference in renal outcome between the
exposed and unexposed patients (OR: 1.25; 95% CI: 0.29–5.37) (Fig 5B).

Sensitivity Analyses
Does the Dose of Corticosteroid Matter?—We investigated if the corticosteroid dose
affects the likelihood of developing persistent renal disease by using unrestricted and
restricted regression models and the likelihood-ratio test. The doses and duration of
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treatment for each study are listed in Table 2. Two studies were excluded from this analysis
because corticosteroid dose was not reported.20,23 The result of the likelihood-ratio test was
statistically insignificant (P = .07), which suggests but fails to identify a significant dose-
response effect.

What Future Study Would Reverse the Findings of This Meta-analysis?—

Sensitivity analyses were performed to determine what sample size and magnitude of effect
of a future hypothetical study would be required to reverse the findings, from the
prospective studies, regarding the benefit of corticosteroid to decrease persistent renal
disease presented in this meta-analysis. We conducted sensitivity analyses with hypothetical
sample sizes of 200 and 400 patients and assuming an incidence of 5% and 20% persistent
renal involvement in the control group (Fig 6). If the baseline risk of renal involvement in
controls is 5%, a new study with 200 patients would need an effect size greater than an OR
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of 3.0 for the pooled OR to reach 1.0. A study with 400 patients would need an effect size
greater than an OR of 2.25 for the new pooled OR to reach 1.0; for the new pooled OR to be
statistically significant, the effect size would need to be larger than 3 (Fig 6A). If the
baseline risk of renal involvement in controls is 20%, the OR of a new study with 200
patients would need to be >1.75 to raise the pooled OR to 1.0 and >3.0 to achieve
significance. A new study with 400 patients would need an OR of >1.4 to raise the pooled
OR to 1.0 and >2.25 to achieve statistical significance (Fig 6B).

DISCUSSION
This systematic review and data summary of 15 eligible articles suggests that early treatment
of corticosteroids for children with HSP is associated with statistically significant increased
odds of abdominal pain resolution within 24 hours and reduced odds of persistent renal
disease. In addition, although the analyses lacked sufficient statistical precision, the
likelihood of surgical intervention and of HSP recurrence may also be reduced. Overall,
across all analyses, the pattern of effect is in the direction favoring the use of corticosteroids;
none of the analyses indicated harm.

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This review emphasizes the necessity for a more complete understanding of the ways in
which corticosteroids impact the course of HSP, in both the acute and chronic settings.
Corticosteroids were first postulated to benefit children with HSP in the 1950s and are
effective in the treatment of other vasculitides in children and adults.25 Corticosteroids are
the cornerstone of treatment for the majority of juvenile vasculitides including systemic
lupus erythematosus, Wegener granulomatosis, polyarteritis nodosa, and Takayasu arteritis.
By contrast, corticosteroid treatment is controversial for use for Kawasaki disease, another
acute childhood vasculitis with potential morbidity and mortality; 1 recent report found no
effect of corticosteroid,26 whereas others have heralded the beneficial effects of
corticosteroids.27,28 Given this information should corticosteroid be given to children who
present to the hospital with new-onset HSP? A rigorous answer to this question would have
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substantial clinical implications. Despite the widespread use of corticosteroids for

vasculitides, there is no consensus yet among physicians as to whether corticosteroids
should be given for HSP and, if so, for what indications.

There are several important potential limitations of the evidence we present. First, the
definition of renal involvement differed among the studies, which means that different
dimensions or degrees of HSP severity were potentially captured. For example, among the 3
prospective studies, the definition of proteinuria ranged from 200 to 400 mg/L, and the
definition of hematuria ranged from 5 to 10 red blood cells per high-powered field. Second,
the dosing regimens and mode of delivery for corticosteroids were not the same in each
study (Table 2). When corticosteroid therapy was stratified by high- versus low-dose
steroids for each of the clinical outcomes, there were no statistical differences between the 2
groups (data not shown). Although various doses of corticosteroids or the method of
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delivery (oral versus intravenous) may affect the size of the risk reduction, these changes in
dose or route are unlikely to reverse the direction of effects. Third, the studies did not
uniformly classify HSP cases as incident or recurrent. Therefore, the potential exists to
inappropriately group severe recurrence with milder recurrence such as rash alone. Like-
wise, given uncertainty about loss to follow-up, particularly in the corticosteroid-treated
group, the protective effect of corticosteroids is likely to be an underestimate.

Two other limitations should be kept in mind when interpreting these data. First, our ability
to draw robust conclusions was hampered by the limited number of prospective studies and
small numbers of patients within the studies, which often resulted in imprecise measures of
treatment effects. Although the effect of corticosteroid on several of the outcomes did
achieve statistically significant evidence of benefit, the failure to demonstrate benefit
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regarding other outcomes and the failure to show a significant dose-response effect may
reflect either the still relatively underpowered nature of the combined existing studies or a
true absence of impact. Second, the effects noted in the retrospective observational studies
probably include some degree of confounding by indication, whereby patients with greater
disease severity were more likely to receive corticosteroids. Given that most of the
retrospective studies nevertheless continued to show a benefit, the results across all studies
are more reassuring.

These caveats not withstanding, our findings suggest that the potential benefit of
corticosteroid administration early in the course of HSP may be more prominent than
previously suggested for both acute (pain, surgical intervention) and chronic (recurrence,
renal disease) complications of disease. If corticosteroid therapy is truly as effective as this
meta-analysis suggests, then broader use of corticosteroid would likely decrease prolonged
hospitalization, the risk of surgery, or chronic renal disease and may, by extension, prove
beneficial even for those seemingly benign cases in female patients who later develop
complications during pregnancy. As demonstrated by the sensitivity analyses, our findings
regarding the potential benefit of corticosteroid to reduce chronic renal disease are robust; to

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reverse our findings, not only would the sample size need to be greater than any published
study on HSP to date, but it also would have to show an OR of harm from corticosteroid
administration >2.25, which is unlikely. Better-designed retrospective studies with
standardization of corticosteroid exposure by accounting for the probability that any patient
would receive corticosteroids and larger prospective, randomized, controlled trials are
needed to assess all clinically relevant outcomes. Knowledge from such studies is essential
for guiding our interventions early in the course of HSP and improving patient outcomes for
both children and adults.

Acknowledgments
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Pamela Weiss is funded, in part, by a National Institutes of Health pharmacoepidemiology T32 training grant.

We thank Frank Pessler, Eric Hanson, Alba Hanson, Jan Boswinkel, Keri Cohn, Eva Lynch, Anna Genin, Kaoru
Saijo, and Lorenza Frisoni for translation of abstracts and articles. We also thank David D. Sherry and James
Guevara for critical reading of the manuscript.

Abbreviations

HSP Henoch-Schönlein purpura

ESRD end-stage renal disease
CCTR Cochrane Controlled Trials Register
OR odds ratio
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CI confidence interval

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FIGURE 1.
Corticosteroid (CS) treatment of HSP and resolution of abdominal pain. A, Prospective:
time to resolution of abdominal pain (days) reported in means and medians. B,
Retrospective: ORs (95% CIs) of abdominal pain resolution within 24 hours of
corticosteroid administration. The box size is proportional to the inverse of the magnitude of
the variance.
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 Weiss et al. Page 10
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FIGURE 2.
Corticosteroid treatment and odds of surgery. Shown are the ORs (95% CIs) of subsequent
surgical intervention for severe abdominal pain and/or intussusception. A, Prospective; B,
retrospective. The box size in B is proportional to the inverse of the magnitude of the
variance.
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 Weiss et al. Page 11
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FIGURE 3.
Corticosteroid treatment of HSP and odds of recurrence. Shown are the ORs (95% CIs) of
HSP recurrence. A, Prospective; B, retrospective. The box sizes are proportional to the
inverse of the magnitude of the variance. No overall OR is displayed in B because of the
heterogeneity of the studies.
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 Weiss et al. Page 12
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FIGURE 4.
Corticosteroid treatment and odds of cumulative incidence of renal disease. Shown are the
ORs (95% CIs) of patients with HSP with cumulative (transient or persistent) renal
involvement if treated early with corticosteroids. A, Prospective; B, retrospective. The box
sizes are proportional to the inverse of the magnitudeof the variance. No overall OR is
displayed because of the heterogeneity of the studies.
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FIGURE 5.
Corticosteroid treatment and odds of persistent renal disease. Shown are the ORs (95% CIs)
of persistent renal involvement after HSP diagnosis. A, Prospective; B, retrospective. An
end point of 1 year was used for the Huber et al11 and Mollica et al14 studies and 6 months
for the Ronkainen et al9 study. The box size in A is proportional to the inverse of the
magnitude of the variance.
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FIGURE 6.
Sensitivity analysis of effect size of future hypothetical studies for likelihood of persistent
renal involvement. Shown are the new combined pooled OR versus OR of a hypothetical
new study with sample sizes of 200 and 400. The prevalence of persistent renal involvement
in the control group was calculated at either 5% (A) or 20% (B).
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TABLE 1
Reasons for Exclusion of Articles
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n
Initial set: total 201

Excluded: totala 186

Review articles2,29–57 30
Case reports with <5 cases3,58–113 79
Therapy with drug(s) other than corticosteroids114–184 54
Focus on patients >18 y old185–189 4
No corticosteroid therapy190 1
Nephritis at onset in all patients5,191–200 11
No extractable outcomes201–206 6
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Not an HSP study207 1

Final set: total 15

a
The references cited (29–207) are available at www.pediatric-generalists.org/Weiss/All-Citations-for-HSP-Systematic-Review.pdf .
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TABLE 2
Summary of Included Articles and Corticosteroid Use

Author Sample Study Design Corticosteroid Dose Initiation of Treatment From

Size Time ofDiagnosis
Weiss et al.

Dose, Duration
mg/kg
per d

Ronkainen etal9(2006) 171 Prospective, randomized, 1 2 wk, weaning over 2 wk At diagnosis

placebo-controlled
Huberetal11 (2004) 40 Prospective, randomized, 2 1 wk, weaning over 1 wk At diagnosis
placebo-controlled
Mollica etal14 (1992) 168 Prospective, randomized, 1 2 wk At diagnosis
placebo-controlled
Trapani etal21 (2005) 150 Retrospective 1–2 Mean of 13.7 d (range: 7–32) Not stated

Gonzalez-Gay and Llorca23 (2005) 78 Retrospective Not stated Not stated

Reinehr etal18 (2000) 101 Retrospective a 1wk <3 wk (46%), >3 wk (54%)
2
Reinehr etal10 (2000) 171 Retrospective a 1wk <3 wk(15%), >3wk(85%)
2
Chao et al20(2000) 20 Retrospective Not stated Range: 3–7 d Not stated

Saulsbury13 (1999) 100 Retrospective b Mean: 8.9 d (range: 5–28 d) Mean: 8.5 d (range: 1–40 d)
1.6
Temmel etal16 (1993) 86 Retrospective 2 1 wk, weaning over 1 wk At diagnosis (30%), at onset of
abdominal pain (70%)
Saulsbury12 (1993) 69 Retrospective c Mean: 8 d (range: 5–10 d) Mean: 5 d (range: 1–19 d)
1.7
Dawodand Akl17 (1990) 40 Retrospective 1–2 Mean: 7 d (range: 3–30 d) Not stated

Buchanec etal22 (1988) 39 Retrospective 1–2.5 10 d, weaning over 1–2 wk At diagnosis

Pediatrics. Author manuscript; available in PMC 2012 December 18.

Buchanec etal15 (1987) 33 Retrospective 1–2.5 10 d, weaning over 1–2 wk At diagnosis

Rosenblum and Winter19 (1987) 43 Retrospective 1–2 Not stated <1 wk(75%), < 12 d (96%)

Shown is a summary of the 15 included articles’ study design, corticosteroid dose, duration of treatment, and timing of treatment in respect to diagnosis.
a
Dose was increased to 3 to 5 mg/kg per day if abdominalpain was present for >24 hours.
b
Mean dose: 1.6 mg/kg per day (range: 1.2–2.0 mg/kg per day).
c
Mean dose: 1.7 mg/kg per day (range: 1.3–2.1 mg/kg per day).
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