Management patterns of childhood-onset nephrotic syndrome.
As an initial effort to identify opportunities to improve the management of children with nephrotic syndrome, the goal of this study was to assess the present-day management of children with primary nephrotic syndrome. A web-based survey was designed to assess the current management styles of all pediatric nephrology faculties at ten participating institutions. Ninety-one percent completed the initial survey. The duration of initial glucocorticoid therapy ranged from 4 to 24 weeks. Physicians reported that the recommendation for kidney biopsy was dependent on the response to initial corticosteroid therapy, with the minority always recommending a biopsy for frequently relapsing or steroid-dependent cases. All responding physicians recommended a kidney biopsy in steroid-resistant cases. Treatment strategies were reported to vary based upon the steroid response pattern and, where available, kidney histopathology. Striking variations in therapeutic preferences were described when alternatives to glucocorticoids were considered. The variability of management practices among pediatric nephrologists in the USA combined with the changing characteristics of our pediatric population raise concerns about our future strategies for improving healthcare for children coping with nephrotic syndrome. This variability is not unique to children's healthcare or to nephrology. However, a systematic approach to patient care and improvement in health outcomes has been shown to substantially improve morbidity and mortality outcomes in children with chronic health conditions.
MacHardy
Nathaniel
N
University of North Carolina at Chapel Hill, 27599-7155, USA.
Miles
Paul V
PV
Massengill
Susan F
SF
Smoyer
William E
WE
Mahan
John D
JD
Greenbaum
Larry
L
Massie
Sara
S
Yao
Lynne
L
Nagaraj
Shashi
S
Lin
Jen-Jar
JJ
Wigfall
Delbert
D
Trachtman
Howard
H
Hu
Yichun
Y
Gipson
Debbie S
DS
D017668:Age of Onset; D001706:Biopsy; D002648:Child; D003625:Data Collection / Q000379:methods; D004351:Drug Resistance; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D020407:Internet; D007668:Kidney / Q000601:surgery; D008297:Male; D015337:Multicenter Studies as Topic; D009398:Nephrology / Q000379:methods*; D009404:Nephrotic Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D012008:Recurrence; D012074:Remission Induction; D013256:Steroids / Q000378:metabolism; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D013256:Steroids