Evidence-based assessment of treatment options for children with IgA nephropathies

We present an evidence-based evaluation of published data on therapy for ch ildren with various presentations of the IgA nephropathies - idiopathic IEA nephropathy (IgAN) and Henoch-Schonlein purpura nephritis (HSPN). Particul ar attention has been paid to the outcome markers used in the studies revie wed, with the best evidence provided by markers highly associated with prog ressive renal failure. No treatment modality for either IgAN or HSPN in ped iatric patients has been shown to be effective by a properly designed and a dministered randomized controlled trial (i.e., the highest level of evidenc e - level 1). Lower levels of evidence support the use of a variety of cort icosteroid regimens, often in combination with other agents, although there are some conflicting studies in this area. No convincing evidence has been published to date to support the use of fish oil, angiotensin-converting e nzyme inhibitors or tonsillectomy for the treatment of children with IgAN o r HSPN. Well designed randomized controlled trials in children with the IgA nephropathies need to be undertaken.