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Clinical Trial
. 2015 Jan;30(1):91-101.
doi: 10.1007/s00467-014-2903-7. Epub 2014 Aug 17.

Best practice guidelines for idiopathic nephrotic syndrome: recommendations versus reality

Andrea Pasini  1 , Gabriella Aceto, Anita Ammenti, Gianluigi Ardissino, Vitalba Azzolina, Alberto Bettinelli, Elena Cama, Sante Cantatore, Antonella Crisafi, Giovanni Conti, Maria D'Agostino, Alessandra Dozza, Alberto Edefonti, Carmelo Fede, Elena Groppali, Chiara Gualeni, Alessandra Lavacchini, Marta Lepore, Silvio Maringhini, Paola Mariotti, Marco Materassi, Francesca Mencarelli, Giovanni Messina, Amata Negri, Marina Piepoli, Fiammetta Ravaglia, Angela Simoni, Laura Spagnoletta, Giovanni Montini; NefroKid Study Group
Collaborators, Affiliations
Clinical Trial

Best practice guidelines for idiopathic nephrotic syndrome: recommendations versus reality

Andrea Pasini et al. Pediatr Nephrol. 2015 Jan.

Abstract

Background: The optimal therapeutic regimen for managing childhood idiopathic nephrotic syndrome (INS) is still under debate. We have evaluated the choice of steroid regimen and of symptomatic treatment adopted by pediatricians and pediatric nephrologists in a large number of centers as the first step towards establishing a shared protocol

Methods: This was a multicenter, retrospective study. A total of 231 children (132 admitted to pediatric units) aged 6 months to <15 years who presented with onset of nephrotic syndrome to 54 pediatric units and six pediatric nephrology units in Italy between 2007 and 2009 were eligible for entry into the study.

Results: Median steroid dosing was 55 (range 27-75) mg/m(2)/day. The overall median cumulative dose regimen for the first episode was 3,440 (1,904-6,035) mg/m(2), and the median duration of the therapeutic regimen was 21 (9-48) weeks. The total duration and cumulative steroid dose were significantly higher in patients treated by pediatricians than in those treated by pediatric nephrologists (p = 0.001 and p = 0.008). Among the patient cohort, 55, 64 and 22 % received albumin infusions, diuretics and acetyl salicylic acid treatment, respectively, but the laboratory and clinical data did not differ between children treated or not treated with symptomatic drugs. Albumin and diuretic use did not vary between patients in pediatric units and those in pediatric nephrology units.

Conclusions: This study shows major differences in steroid and symptomatic treatment of nephrotic syndrome by pediatricians and pediatric nephrologists. As these differences can influence the efficacy of the treatments and the appearance of side-effects, shared guidelines and their implementation through widespread educational activities are necessary.

Trial registration: ClinicalTrials.gov NCT01386957.

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Figures

Fig. 1
Fig. 1
Flowchart of the 231 enrolled pediatric patients
Fig. 2
Fig. 2
Treatment regimen for the first episode. a, b Duration (a) and total prednisone dose utilized (b) for the total patient cohort. c–f Comparison of the duration (c, d) and total prednisone dose (e, f) of the steroid regimen for the first episode used by participating pediatricians (c, e) and pediatric nephrologists (d, f). Y-axis shows the number of patients. PDN Prednisone
See this image and copyright information in PMC

References

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