Department of Public Health, Kitasato University School of Medicine, Kanagawa, Japan.
Department of Nephrology, Juntendo University Urayasu Hospital, Chiba, Japan.
Clin Exp Nephrol. 2023 Dec;27(12):1032-1041. doi: 10.1007/s10157-023-02396-0. Epub 2023 Aug 30.
In 2020, the Committee of Clinical Practical Guideline for IgA Nephropathy (IgAN) revised the clinical practice guidelines. Herein, we conducted a questionnaire survey to assess the potential discrepancies between clinical practice guidelines and real-world practice in Japan.
A web-based survey of members of the Japanese Society of Nephrology was conducted between November 15 and December 28, 2021.
A total of 217 members (internal physicians: 203, pediatricians: 14) responded to the questionnaire. Of these respondents, 94.0% answered that the clinical practice guidelines were referred to "always" or "often." Approximately 66.4% respondents answered that histological grade (H-Grade) derived from the "Clinical Guidelines for IgA nephropathy in Japan, 3rd version" and the "Oxford classification" were used for pathological classification. Moreover, 73.7% respondents answered that the risk grade (R-grade) derived from the "Clinical Guidelines for IgA nephropathy in Japan, 3rd version" was referred to for risk stratification. The prescription rate of renin-angiotensin system blockers increased based on urinary protein levels (> 1.0 g/day: 88.6%, 0.5-1.0 g/day: 71.0%, < 0.5 g/day: 25.0%). Similarly, the prescription rate of corticosteroids increased according to proteinuria levels (> 1.0 g/day: 77.8%, 0.5-1.0 g/day: 52.8%, < 0.5 g/day: 11.9%). The respondents emphasized on hematuria when using corticosteroids. In cases of hematuria, the indication rate for corticosteroids was higher than in those without hematuria, even if the urinary protein level was 1 g/gCr or less. Few severe infectious diseases or serious deterioration in glycemic control were reported during corticosteroid use.
Our questionnaire survey revealed real-world aspects of IgAN treatment in Japan.
2020 年，IgA 肾病（IgAN）临床实践指南委员会对临床实践指南进行了修订。在此，我们进行了一项问卷调查，以评估日本临床实践指南与真实世界实践之间的潜在差异。
2021 年 11 月 15 日至 12 月 28 日，对日本肾脏病学会成员进行了一项基于网络的调查。
共有 217 名成员（内科医生：203 名，儿科医生：14 名）回答了问卷。这些回答者中，94.0%回答“经常”或“总是”参考临床实践指南。约 66.4%的回答者回答说，组织学分级（H 级）源自《日本 IgA 肾病临床指南，第 3 版》和《牛津分类》，用于病理分类。此外，73.7%的回答者回答说，风险分级（R 级）源自《日本 IgA 肾病临床指南，第 3 版》，用于风险分层。根据尿蛋白水平（>1.0 g/天：88.6%，0.5-1.0 g/天：71.0%，<0.5 g/天：25.0%），肾素-血管紧张素系统阻滞剂的处方率增加。同样，根据蛋白尿水平（>1.0 g/天：77.8%，0.5-1.0 g/天：52.8%，<0.5 g/天：11.9%），皮质类固醇的处方率增加。回答者在使用皮质类固醇时强调血尿。在有血尿的情况下，即使尿蛋白水平为 1 g/gCr 或更低，皮质类固醇的适应证率也高于无血尿的情况。在使用皮质类固醇期间，很少有严重的感染性疾病或血糖控制严重恶化的报告。
我们的问卷调查揭示了日本 IgAN 治疗的真实世界情况。
