Lack of benefit of steroids for the prevention of Henoch–Schönlein purpura-associated nephritis

With a lack of evidence to support their use, the role of steroids in preventing Henoch–Schönlein purpura (HSP)-associated nephritis has remained controversial. In this well-conducted, multicentre, blinded, randomised placebo-controlled trial, Dudley et al. provide high-quality evidence for a lack of benefit of steroids in preventing HSP nephritis.[1] In their study, 352 children with HSP were randomised to either prednisolone (2 mg/kg/day for 7 days; 1 mg/kg/day for 7 days) or placebo for 14 days. Follow-up assessments were done at 4 weeks, 3 months and 12 months. The primary outcome was the presence of proteinuria (urine protein : creatinine (UP : UC) of >20 mg/mmol) at 12 months. At 12 months, only 70% of patients had urine samples available for analysis for the primary outcome. However, despite this, there was no difference in the proportion of children that had a UP : UC > 20 mg/mmol, even after controlling for baseline proteinuria and medications that may affect the level of proteinuria (odds ratio 1.29 (95% confidence interval 0.58–2.82)). The most common reason for unblinding was the presence of severe abdominal pain. The study by Dudley et al. provides paediatricians with the best available evidence to date and does not support a role for steroids in preventing HSP nephritis.


Reviewers: Victoria Casey,; Candie Chong,; Tom Connell,