VDR-Mediated Immunomodulation in Pediatric IgA Vasculitis: A Systematic Review of the Evidence Base for Alfacalcidol

Rusdian Niati Ningsih (Department of Child Health Faculty of Medicine, Universitas Airlangga)
Anang Endaryanto (Department of Child Health Faculty of Medicine, Universitas Airlangga)
Zahrah Hikmah (Department of Child Health Faculty of Medicine, Universitas Airlangga)
Azwin Mengindra Putera (Department of Child Health Faculty of Medicine, Universitas Airlangga)

Jurnal Media Gizi Indonesia (MGI)
Vol. 21 No. 4 (2026): MEDIA GIZI INDONESIA

Henoch-Schönlein Purpura (HSP), or IgA vasculitis, is the most common systemic vasculitis in children, with nephritis being the primary cause of long-term morbidity. Current therapeutic options remain limited, and the immunomodulatory properties of vitamin D analogs have prompted interest in alternative treatment approaches. This systematic review aimed to consolidate and critically appraise the existing clinical evidence regarding the efficacy of alfacalcidol as an adjunctive therapy in the management of pediatric Henoch-Schönlein purpura. A systematic literature search was conducted across MEDLINE (PubMed), ScienceDirect, Cochrane CENTRAL, and LILACS from inception through January 15, 2026, following the PRISMA guidelines. Eligible studies included pediatric patients (<18 years) with confirmed HSP who received alfacalcidol therapy and reported renal outcomes, relapse rates, or symptom resolution. Risk of bias was assessed independently by two reviewers using the Cochrane RoB 2 tool, and the certainty of evidence was evaluated using GRADE. PROSPERO 2026 CRD420261399662. Two prospective controlled trials from China (255 children) were included in this study. A limited exploratory within-group pre-post quantitative synthesis of clinical severity scores (alfacalcidol arm only) showed a pooled mean change of −19.98 (95% CI −21.95 to −18.02; I²=0%).