Efficacy and safety of traditional Chinese medicine in treating pediatric IgA vasculitis nephritis: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND

IgA vasculitis nephritis (IgAVN) is an important cause of secondary glomerulonephritis and long-term renal morbidity in children. Traditional Chinese medicine (TCM) interventions are widely used for pediatric IgAVN, either alone or combined with Western medicine, but their efficacy and safety remain uncertain. This study evaluated the efficacy and safety of TCM interventions in children with IgAVN.

METHODS

Eight databases were searched from inception to March 7, 2025, for randomized controlled trials comparing TCM interventions with Western medicine alone in children with IgAVN. The primary outcome was the overall clinical effective rate. Secondary outcomes included 24-hour urinary protein excretion, urinary red blood cell count, β2-microglobulin, D-dimer, and adverse events. Meta-analyses were performed using RevMan 5.4. Risk of bias was assessed using the Cochrane risk-of-bias tool, and certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach.

RESULTS

Nineteen randomized controlled trials involving 1764 children were included. Compared with Western medicine alone, TCM interventions improved the overall clinical effective rate (risk ratio = 1.20, 95% confidence interval [CI] = [1.15-1.25], P < .00001) and reduced 24-hour urinary protein excretion (standardized mean difference = -0.83, 95% CI = [-1.12 to -0.54], P < .00001) and β2-microglobulin levels (standardized mean difference = -0.54, 95% CI = [-0.70 to -0.38], P < .00001). Sensitivity analyses suggested possible reductions in urinary red blood cell count and D-dimer levels after excluding heterogeneous trials. The incidence of adverse events did not differ significantly between groups (risk ratio = 0.92, 95% CI = [0.60-1.40], P = .70). The certainty of evidence ranged from moderate to very low.

CONCLUSION

The TCM interventions included in this review may provide short-term benefits in clinical response and selected renal-related laboratory outcomes in children with IgAVN, without increasing the observed incidence of adverse events. High-quality randomized trials with standardized outcomes, structured safety monitoring, and longer follow-up are needed.