title: Uncertainty in management of childhood-onset idiopathic nephrotic syndrome: is the long-term prognosis really favorable?
abstract: Despite the recent establishment of clinical practice guidelines, many areas in the management of childhood idiopathic nephrotic syndrome (INS) remain uncertain. In this edition of Pediatric Nephrology Samuel et al. report significant differences between Canadian pediatric nephrologists' practice and guideline recommendations, including initial duration of glucocorticoid treatment, choice of glucocorticoid-sparing agents in cases of frequently relapsing or steroid-dependent INS, and biopsy timing. Although evidence is emerging that the incidence of subsequent relapse can be reduced with longer initial glucocorticoid therapy, even with this new regimen relapse occurs in more than half of the children with steroid-sensitive INS. Cyclosporine (CsA) as a glucocorticoid-sparing agent for children with frequently relapsing or steroid-dependent INS is believed to provide protection from steroid toxicity and significantly improve the quality of life. However, recent follow-up studies of the post-CsA era have revealed a high incidence of INS relapse in adulthood in patients treated with CsA in childhood, and CsA use itself is a significant predictor of recurrent relapses. Therefore, pediatric nephrologists must recognize the potential of adverse effects that may appear later in life because of prolonged immunosuppressive therapy in childhood.
authors.affiliation: Divisions of Nephrology, Saitama Children's Medical Center, 2100 Magome, Iwatsuki-ku, Saitama City, Saitama, 339 8551, Japan, f_shuich@d2.dion.ne.jp.
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Fujinaga
authors.forename: Amane
authors.initials: A
authors.lastname: Endo
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Ohtomo
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Ohtsuka
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Shimizu
mesh_terms: D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D009404:Nephrotic Syndrome / Q000188:drug therapy*; D010818:Practice Patterns, Physicians'
chemical_list: D007166:Immunosuppressive Agents