title: Substantial practice variation exists in the management of childhood nephrotic syndrome.
abstract: BACKGROUND
  Practice variation is common for nephrotic syndrome (NS) treatment.
  
  
  METHODS
  A cross-sectional, web-based survey on NS treatment was administered to 58 Canadian pediatric nephrologists with the aim to document existing practice variation and compare practice with the recommendations of the Kidney Disease Improving Global Outcomes Clinical Practice Guideline for NS.
  
  
  RESULTS
  Of the 58 nephrologists asked to participate in the survey, 40 (69 %) responded. Among these, 62 % prescribed initial daily glucocorticoid (GC) therapy for 6 weeks, 26 % for 4 weeks by 26 %, and 10 % prescribed 'other'. Alternate-day GC was continued for 6 weeks by 63 % of respondents and for >6 and <6 weeks by 32 and 6 %, respectively. For biopsy-confirmed minimal change disease, 65 and 46 % of respondents chose oral cyclophosphamide for frequently relapsing and steroid-dependent phenotypes, respectively; calcineurin inhibitors or mycophenolate were the second most popular choices. Kidney biopsy was 'always' performed by 16, 39, and 97 % of respondents for frequently relapsing, steroid-dependent, and steroid-resistant patients, respectively. Rituximab had been administered by 60 % of respondents; 22, 56, and 72 % reported that they would consider rituximab for frequently relapsing, steroid-dependent, and steroid-resistant patients, respectively. Most notable differences between practice and Guideline recommendations were first presentation GC duration, GC-sparing agent choices in frequently relapsing and steroid-dependent patients, and biopsy practices.
  
  
  CONCLUSIONS
  There is substantial Canadian practice variation in NS treatment. Assessment of factors driving variation and strategies to implement Guideline recommendations are needed.
authors.affiliation: Department of Pediatrics, Division of Nephrology, University of Calgary and Alberta Children's Hospital Research Institute for Child and Maternal Health, Calgary, AB, Canada.
authors.forename: Susan
authors.initials: S
authors.lastname: Samuel
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Morgan
authors.forename: Martin
authors.initials: M
authors.lastname: Bitzan
authors.forename: Cherry
authors.initials: C
authors.lastname: Mammen
authors.forename: Allison B
authors.initials: AB
authors.lastname: Dart
authors.forename: Braden J
authors.initials: BJ
authors.lastname: Manns
authors.forename: R Todd
authors.initials: RT
authors.lastname: Alexander
authors.forename: Robin L
authors.initials: RL
authors.lastname: Erickson
authors.forename: Silviu
authors.initials: S
authors.lastname: Grisaru
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Wade
authors.forename: Tom
authors.initials: T
authors.lastname: Blydt-Hansen
authors.forename: Janusz
authors.initials: J
authors.lastname: Feber
authors.forename: Steven
authors.initials: S
authors.lastname: Arora
authors.forename: Christoph
authors.initials: C
authors.lastname: Licht
authors.forename: Michael
authors.initials: M
authors.lastname: Zappitelli
mesh_terms: D000328:Adult; D017668:Age of Onset; D001706:Biopsy; D002170:Canada / Q000453:epidemiology; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D020407:Internet; D008297:Male; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D012008:Recurrence; D012074:Remission Induction; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents
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