Table 1 Characteristics of the studies included in this meta-analysis

Garin 1988

Single center, cross-over, randomized clinical trial

CsA vs. P/NT

In CsA group, the initial dosage was 5 mg/kg/d, and then sustained 200 ng/ml or less. The total treatment course was 8 weeks. In control group, any immunosuppressive agent was not allowed.

Six male and two females with idiopathic, SRNS were enrolled. The median age was 12 (3, 18) years. Four patients had MCD and the other four were diagnosed with FSGS. All the patients were Children. Initially, four patients in group of CsA and four patients in P/NT group.

Urinary protein excretion values, creatinine clearance values, serum albumin values, etc.

Hypertension, renal function deterioration, liver function disorder, etc.

Ponticelli 1993

Multicenter randomized clinical trial

CsA vs. P/NT

CsA was administered orally and the initial dose was divided into two doses (6 mg/kg/day for children and 5 mg/kg/day for adults). The CsA level was maintained between 250 and 600 ng/ml, and CsA discontinued after six months. For patients who responded, the CsA dose was reduced by 25% every two months, so that CsA treatment was stopped by the end of the year. Patients in control group were given only supportive treatment for one year.

The following characteristics met included criterion: 1) Patients had nephrotic syndrome; 2) The creatinine clearance was more than 80 ml/min/1.73m² for children 60 ml/min/1.73m² for adults; 3) The renal biopsies showed either MCD or FSGS. The patients included children and adults. 22 patients were in CsA group and 19 patients were in P/NT group.

CR, TR, proteinuria, serum creatinine, creatinine clearance values, serum urea, serum proteins, serum albumin values, plasma cholesterol, etc.

Infections, gum hyperplasia, hypertrichosis, transient gastric discomfort, conjugated bilirubinemia, headache, bronchospasm, paresthesia, etc.

Lieberman 1996

Multicenter randomized clinical trial

CsA vs. P/NT

CsA was administered as the 100 mg/ml suspension. The initial dose was 3 mg/kg of CsA twice daily as to attaining a target CsA level within the range of 300 to 500 ng/mL. Placebo patients were received a vehicle control.

Age of patients was between 6 months and 21 years. 15 patients were in CsA group and 15 patients were in P/NT group.

CR, TR, proteinuria, serum creatinine, serum albumin values, plasma cholesterol, potassium, uric acid, magnesium, etc.

Infections, hypertension, gum hyperplasia, etc.

Plank 2008

Multicenter randomized clinical trial

CsA vs. CYC

The initial dose of CsA was 150 mg/m² BSA twice per day in CsA group. If the proteinura decrease < 40 mg/m²/hour within the first 12 weeks during the CsA therapy, patients were recruited into the non-responder protocol with CsA dose increasing to 350 ng/ml (range 300–400 ng/ml). In control group, patients were administered 500 mg/m² BSA CYC pulse therapy in a 4-h infusion. The infusion treatment was repeated in 4,8,12,16,24 and 36 weeks.

Patients from children with gross proteinuria > 40 mg/m² BSA per hour (equivalent to 1 g/m²/24h) and hypoalbuminemia (< 25 g/l) were included. All patients were diagnosed as MCD, FSGS or diffuse mesangial proliferation by renal biopsy. 15 patients were in CsA group and 17 patients were in CYC group.

CR, TR, etc.

Infections, hypertension, headache, gum hyperplasia, hypertrichosis, transient gastric discomfort, etc.

Choudhry 2009

Single center Randomized clinical trial

CsA vs. TAC

The initial dose of TAC was 0.1 to 0.2 mg/kg/d or CsA at 5 to 6 mg/kg/d in two divided doses for 12-month. Patients in two groups got oral prednisolone 1 mg/kg (on alternate days) for 6 months, followed by 0.5 mg/kg for the next 6-month, and enalapril was administered at the dose of 0.2 to 0.3 mg/kg/d.

Patients with the following traits were eligible for study 1) Age ranged from 1 to 18 years with idiopathic SRNS; 2) Renal histological characteristics suggested of MCD, mesangioproliferative glomerulonephritis or FSGS. 20 patients were in CsA group and 21 patients were in TAC group.

CR, TR, etc.

Infections, hypertension, headache, gum hyperplasia, hypertrichosis, paresthesia, etc.

Geng 2018

Single center Randomized clinical trial

CsA vs. MMF

In CsA group, CsA was administered orally 3~5 mg/kg twice a day, and maintained between 80 and 120 μg/L. The maintenance dose of effective patients was 1–3 mg/(kg·d) and their induction period was reduced after 6 months. In MMF group, the dose was administered orally in 2 patterns, either 15–30 mg/(kg·d) or 800~1200 mg/(m²·d). The MMF was discontinued if the decreasing in proteinuria was less than 50%, or continued to treat after 6 months of induction with maintenance dose of 10–20 mg/(kg·d). The total course was 12 months.

30 pediatric patients aged from 2.1 to 17.0 years presented with SRNS. The renal histological characteristics indicated MCD, mesangioproliferative glomerulonephritis, MN or FSGS. 18 patients were in CsA group and 14 patients were in MMF group.

CR, TR, etc.

Respiratory infections, nausea, vomiting, abdominal pain, diarrhea and other gastrointestinal symptoms, etc.