Department of Pediatrics, Division of Nephrology, University of Calgary and Alberta Children's Hospital Research Institute for Child and Maternal Health, Calgary, AB, Canada.
Pediatr Nephrol. 2013 Dec;28(12):2289-98. doi: 10.1007/s00467-013-2546-0. Epub 2013 Aug 6.
Practice variation is common for nephrotic syndrome (NS) treatment.
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.
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.
There is substantial Canadian practice variation in NS treatment. Assessment of factors driving variation and strategies to implement Guideline recommendations are needed.
肾病综合征（NS）的治疗存在实践差异。
采用横断面、基于网络的调查方法，对 58 名加拿大儿科肾病学家进行 NS 治疗，旨在记录现有的实践差异，并将其与肾脏病改善全球结局组织临床实践指南（KDIGO）对 NS 的推荐意见进行比较。
在被要求参与调查的 58 名肾病学家中，有 40 名（69%）做出了回应。其中，62%的医生初始每日给予糖皮质激素（GC）治疗 6 周，26%的医生给予 4 周，10%的医生给予“其他”方案。63%的受访者继续隔日 GC 治疗 6 周，32%和 6%的受访者分别继续治疗>6 周和<6 周。对于活检证实的微小病变性肾病，分别有 65%和 46%的受访者选择环磷酰胺口服治疗频繁复发和激素依赖表型；钙调神经磷酸酶抑制剂或霉酚酸酯是第二受欢迎的选择。16%、39%和 97%的受访者分别对频繁复发、激素依赖和激素耐药的患者“总是”进行肾脏活检。60%的受访者使用了利妥昔单抗；22%、56%和 72%的受访者分别报告称，他们会考虑将利妥昔单抗用于频繁复发、激素依赖和激素耐药的患者。实践与指南推荐意见之间最显著的差异是初次就诊时 GC 持续时间、频繁复发和激素依赖患者的 GC 节省药物选择，以及活检实践。
加拿大在 NS 治疗方面存在大量实践差异。需要评估驱动差异的因素，并制定实施指南推荐意见的策略。
