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Practice variations in the management of childhood nephrotic syndrome in the Netherlands
- Source :
- European Journal of Pediatrics, 180(6):180, 1885-1894. Springer-Verlag, European Journal of Pediatrics, 180, 6, pp. 1885-1894, European Journal of Pediatrics, 180(6), 1885-1894. Springer Verlag, European Journal of Pediatrics, European Journal of Pediatrics, 180, 1885-1894, European journal of pediatrics, 180(6), 1885-1894. Springer Verlag, Schijvens, A M, van der Weerd, L, van Wijk, J A E, Bouts, A H M, Keijzer-Veen, M G, Dorresteijn, E M & Schreuder, M F 2021, ' Practice variations in the management of childhood nephrotic syndrome in the Netherlands ', European Journal of Pediatrics, vol. 180, no. 6, pp. 1885-1894 . https://doi.org/10.1007/s00431-021-03958-8
- Publication Year :
- 2021
-
Abstract
- Nephrotic syndrome in childhood is a common entity in the field of pediatric nephrology. The optimal treatment of children with nephrotic syndrome is often debated. Previously conducted studies have shown significant variability in nephrotic syndrome management, especially in the choice of steroid-sparing drugs. In the Netherlands, a practice guideline on the management of childhood nephrotic syndrome has been available since 2010. The aim of this study was to identify practice variations and opportunities to improve clinical practice of childhood nephrotic syndrome in the Netherlands. A digital structured survey among Dutch pediatricians and pediatric nephrologists was performed, including questions regarding the initial treatment, relapse treatment, kidney biopsy, additional immunosuppressive treatment, and supportive care. Among the 51 responses, uniformity was seen in the management of a first presentation and first relapse. Wide variation was found in the tapering of steroids after alternate day dosing. Most pediatricians and pediatric nephrologists (83%) would perform a kidney biopsy in case of steroid-resistant nephrotic syndrome, whereas for frequent relapsing and steroid-dependent nephrotic syndrome this was 22% and 41%, respectively. Variation was reported in the steroid-sparing treatment. Finally, significant differences were present in the supportive treatment of nephrotic syndrome.Conclusion: Substantial variation was present in the management of nephrotic syndrome in the Netherlands. Differences were identified in steroid tapering, use of steroid coverage during stress, choice of steroid-sparing agents, and biopsy practice. To promote guideline adherence and reduce practice variation, factors driving this variation should be assessed and resolved. What is Known:• National and international guidelines are available to guide the management of childhood nephrotic syndrome.• Several aspects of the management of childhood nephrotic syndrome, including the choice of steroid-sparing drugs and biopsy practice, are controversial and often debated among physicians.What is New:• Significant practice variation is present in the management of childhood nephrotic syndrome in the Netherlands, especially in the treatment of FRNS, SDNS, and SRNS.• The recommendation on the steroid treatment of a first episode of nephrotic syndrome in the KDIGO guideline leaves room for interpretation and is likely the cause of substantial differences in steroid-tapering practices among Dutch pediatricians and pediatric nephrologists.
- Subjects :
- Pediatrics
medicine.medical_specialty
030232 urology & nephrology
Nephrotic syndrome
Childhood nephrotic syndrome
Clinical practice
Guidelines
03 medical and health sciences
0302 clinical medicine
Recurrence
Biopsy
Medicine
Pediatric nephrology
Humans
030212 general & internal medicine
Dosing
Child
Glucocorticoids
Netherlands
First episode
medicine.diagnostic_test
business.industry
Guideline
medicine.disease
Clinical Practice
Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11]
Pediatrics, Perinatology and Child Health
Original Article
business
Immunosuppressive Agents
Subjects
Details
- Language :
- English
- ISSN :
- 03406199 and 18851894
- Volume :
- 180
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- European journal of pediatrics
- Accession number :
- edsair.doi.dedup.....1ae138c9a39a6217caf76bae78c8458c
- Full Text :
- https://doi.org/10.1007/s00431-021-03958-8