title: Best practice guidelines for idiopathic nephrotic syndrome: recommendations versus reality.
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.
authors.affiliation: Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliero Universitaria Sant'Orsola-Malpighi, Via Massarenti 11, 40138, Bologna, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Pasini
authors.forename: Gabriella
authors.initials: G
authors.lastname: Aceto
authors.forename: Anita
authors.initials: A
authors.lastname: Ammenti
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Ardissino
authors.forename: Vitalba
authors.initials: V
authors.lastname: Azzolina
authors.forename: Alberto
authors.initials: A
authors.lastname: Bettinelli
authors.forename: Elena
authors.initials: E
authors.lastname: Cama
authors.forename: Sante
authors.initials: S
authors.lastname: Cantatore
authors.forename: Antonella
authors.initials: A
authors.lastname: Crisafi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Conti
authors.forename: Maria
authors.initials: M
authors.lastname: D'Agostino
authors.forename: Alessandra
authors.initials: A
authors.lastname: Dozza
authors.forename: Alberto
authors.initials: A
authors.lastname: Edefonti
authors.forename: Carmelo
authors.initials: C
authors.lastname: Fede
authors.forename: Elena
authors.initials: E
authors.lastname: Groppali
authors.forename: Chiara
authors.initials: C
authors.lastname: Gualeni
authors.forename: Alessandra
authors.initials: A
authors.lastname: Lavacchini
authors.forename: Marta
authors.initials: M
authors.lastname: Lepore
authors.forename: Silvio
authors.initials: S
authors.lastname: Maringhini
authors.forename: Paola
authors.initials: P
authors.lastname: Mariotti
authors.forename: Marco
authors.initials: M
authors.lastname: Materassi
authors.forename: Francesca
authors.initials: F
authors.lastname: Mencarelli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Messina
authors.forename: Amata
authors.initials: A
authors.lastname: Negri
authors.forename: Marina
authors.initials: M
authors.lastname: Piepoli
authors.forename: Fiammetta
authors.initials: F
authors.lastname: Ravaglia
authors.forename: Angela
authors.initials: A
authors.lastname: Simoni
authors.forename: Laura
authors.initials: L
authors.lastname: Spagnoletta
authors.forename: Giovanni
authors.initials: G
authors.lastname: Montini
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009404:Nephrotic Syndrome / Q000188:drug therapy*; D010372:Pediatrics / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies