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Substantial practice variation exists in the management of childhood nephrotic syndrome

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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.

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Acknowledgments

We sincerely thank all the Canadian pediatric nephrologists who completed the online survey regarding their management practices in childhood nephrotic syndrome. We gratefully acknowledge the support provided by the Canadian Kidney Knowledge Translation and Generation Network and the Canadian Association of Pediatric Nephrologists in the conduct and completion of this study.

Disclosures (funding)

SS received salary award support from the Kidney Research Scientist Core Education and National Training Program (Kidney Foundation of Canada, Canadian Institutes for Health Research, Canadian Society of Nephrology) and Canadian Child Health Clinician Scientist Program. MZ received salary support from the Fonds de Recherche du Québec–Santé.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Nephrology, University of Calgary and Alberta Children’s Hospital Research Institute for Child and Maternal Health, Calgary, AB, Canada

    Susan Samuel, Silviu Grisaru & Andrew W. Wade

  2. Department of Pediatrics, University of Alberta–Stollery Children’s Hospital, Edmonton, AB, Canada

    Catherine J. Morgan & R. Todd Alexander

  3. Department of Pediatrics, Division of Nephrology, McGill University Health Centre–Montreal Children’s Hospital, 2300 Tupper, Rm E-213, Montreal, QC, H3H 1P3, Canada

    Martin Bitzan & Michael Zappitelli

  4. Department of Pediatrics, Division of Pediatric Nephrology, British Columbia Children’s Hospital, Vancouver, BC, Canada

    Cherry Mammen

  5. Department of Pediatrics and Child Health, Section of Nephrology, University of Manitoba, Winnipeg, MB, Canada

    Allison B. Dart & Tom Blydt-Hansen

  6. Department of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada

    Braden J. Manns

  7. Department of Pediatrics, Division of Pediatric Nephrology, University of Saskatchewan, Saskatoon, SK, Canada

    Robin L. Erickson

  8. Department of Pediatrics, Division of Nephrology, University of Ottawa–Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada

    Janusz Feber

  9. Department of Pediatrics, Division of Nephrology, McMaster University–McMaster Children’s Hospital, Hamilton, ON, Canada

    Steven Arora

  10. Department of Pediatrics, Division of Nephrology, Sickkids Hospital, Toronto, ON, Canada

    Christoph Licht

Authors
  1. Susan Samuel
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  2. Catherine J. Morgan
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  3. Martin Bitzan
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  4. Cherry Mammen
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  5. Allison B. Dart
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  6. Braden J. Manns
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  7. R. Todd Alexander
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  8. Robin L. Erickson
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  9. Silviu Grisaru
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  10. Andrew W. Wade
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  11. Tom Blydt-Hansen
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  12. Janusz Feber
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  13. Steven Arora
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  14. Christoph Licht
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  15. Michael Zappitelli
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Corresponding author

Correspondence to Michael Zappitelli.

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Samuel, S., Morgan, C.J., Bitzan, M. et al. Substantial practice variation exists in the management of childhood nephrotic syndrome. Pediatr Nephrol 28, 2289–2298 (2013). https://doi.org/10.1007/s00467-013-2546-0

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  • DOI: https://doi.org/10.1007/s00467-013-2546-0

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