The problem of transition from pediatric to adult healthcare in patients with steroid-sensitive nephrotic syndrome (SSNS): a survey of the experts.
BACKGROUND
The importance of the transition from pediatric to adult healthcare has recently been recognized. In patients with steroid-sensitive nephrotic syndrome (SSNS), the shift in steroid dose during the transition period is a big problem. Thus, change in treatment methods during this transition need to be clarified.


METHODS
Questionnaires were sent to all councilors of the Japanese Society for Pediatric Nephrology who managed SSNS in children. The questionnaires asked about steroid dose, informed consent, and transition programs. Councilors in 50 of 57 (87.7 %) institutes responded within 2 weeks.


RESULTS
About one-third of pediatric nephrologists (PNs) did not transfer patients to adult units, and half of PNs followed patients after they reached adulthood (i.e., age >20 years). The dose of steroids after puberty varied between doctors, but 74 % of PNs provided short-term daily therapy. 72 % of PNs informed the patients of the shift in steroid dose, but 26 % of PNs did not. About two-thirds of PNs did not consult with adult nephrologists before the transition from pediatric to adult care. No institute had a transition program for SSNS and 2 institutes had transition coordinators.


CONCLUSIONS
Transition programs are needed in Japan. But the difference in the steroid regimen between pediatric and adult patients with SSNS is a barrier to transition. This difference needs to be discussed.
Department of Pediatric Nephrology, Tokyo Metropolitan Children's Medical Center, Japanese Society for Pediatric Nephrology (JSPN), Musashidai 2-8-29, Fuchu, Tokyo, 183-8561, Japan, mhond@fol.hi-ho.ne.jp.
Masataka
M
Honda
Kazumoto
K
Iijima
Kenji
K
Ishikura
Kazunari
K
Kaneko
D000293:Adolescent; D000367:Age Factors; D003695:Delivery of Health Care / Q000639:trends*; D004305:Dose-Response Relationship, Drug; D006306:Health Surveys; D006801:Humans; D007564:Japan; D009404:Nephrotic Syndrome / Q000188:drug therapy*; D012017:Referral and Consultation; D013038:Specialization; D013256:Steroids / Q000627:therapeutic use*; D011795:Surveys and Questionnaires; D060305:Transition to Adult Care / Q000639:trends*; D055815:Young Adult
D013256:Steroids