Bagga 2004

Methods	Study design: cross‐over RCT Time frame: not reported Follow‐up period: 20 weeks; first part of cross‐over included so outcome at 8 weeks used
Participants	Setting: tertiary centre Country: India SRNS (no remission after 8 weeks of prednisone); patients with initial SRNS (15) or late SRNS (10) following response to prednisone Number (high dose/low dose): 14/11 Age (range) High dose: 78 months (60 to 104.7) Low dose: 96 months (80.5 to 136.4) Sex (M/F) High dose: 9/5 Low dose: 9/2 Histology High dose: MCD (3); FSGS (5); MCGN (3); MesPGN (3) Low dose: MCD (1); FSGS (4); MCGN (4) Exclusion criteria: severe hypertension (SBP or DBP > 99th percentile); GFR < 70 mL/min/1.73 m2; secondary nephrotic syndrome (SLE, HSP, Hepatitis B, amyloidosis); single functioning kidney; treatment with daily prednisone, IV steroids, alkylating agents, levamisole, CSA, IV albumin in previous 4 weeks; patients unable to attend 4 weekly visits; age < 1 year or > 16 years
Interventions	High dose enalapril 0.6 mg/kg/d for 8 weeks in 2 doses Low dose enalapril 0.2 mg/kg/d for 8 weeks in 2 doses Co‐interventions Alternate day prednisone, frusemide
Outcomes	Urine albumin/Cr ratios (median, 95% CI) after 8 weeks Urine albumin/Cr reduction (median, 95% CI) after 8 weeks Levels of Cr, albumin, cholesterol, potassium, BP Adverse events: cough
Notes	Exclusions post randomisation but pre‐intervention: 4 (high dose group (1), low dose group (3)) excluded after randomisation and before treatment Stop or end points/s: not reported Additional data requested from authors: Information on allocation concealment, study characteristics and results received from authors
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Computer generated random numbers
Allocation concealment (selection bias)	Low risk	Sealed opaque envelopes opened by investigator, who did not manage the patients (information from author)
Blinding of participants and personnel (performance bias) All outcomes	High risk	No blinding of participants or investigators; lack of blinding could influence management
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Laboratory assessment of outcome unlikely to be influenced by lack of blinding
Incomplete outcome data (attrition bias) All outcomes	Low risk	All patients randomised were included and completed the study (information from authors)
Selective reporting (reporting bias)	High risk	Outcomes reported (urinary albumin excretion, kidney function, adverse events) but no results could be included in meta‐analyses
Other bias	Unclear risk	Funding source not stated