There are no substantial changes in comclusions from this update compared with the initial review. From generally low quality evidence, we found no evidence of benefit from RCTs for the use prednisone or antiplatelet agents to prevent persistant kidney disease in children with HSP. Though heparin appeared effective, this potentially dangerous therapy is not justified to prevent serious kidney disease when fewer than 2% of children with HSP develop severe kidney disease. No evidence of benefit has been found for cyclophosphamide treatment in children or adults with HSP and severe liney disease. Because of small patient numbers and events leading to imprecision in results, it remains unclear whether cyclosporine and mycophenolate mofetil have any roles in the treatment of children with HSP and severe kidney disease.