Variability among pediatric nephrologists in the initial therapy of nephrotic syndrome

The objective of this study was to describe the practices of North American pediatric nephrologists in treating new-onset steroid-sensitive nephrotic syndrome and impressions regarding the effect of therapy duration on the risk of relapse. A questionnaire was mailed to 130 pediatric nephrologists in the United States and Canada. One hundred and five (81%) replied. Of the respondents, 39% believed a longer steroid regimen results in more-sustained remissions; 19% did not; 18% believed perhaps, but not enough to risk the increased side-effects of the longer steroid regimen; and 24% did not know. Half of the respondents prescribed an 8-week regimen and 21% prescribed a 12-week regimen; however, in 70% of both regimens, respondents appended an additional taper. The remaining respondents either tapered at urinary remission (14%) or used another regimen (15%). Physicians using the 12-week regimen expected 44% of patients to be relapse free at 1 year, compared with 31% of patients of respondents using other regimens (P=0.005). Over the previous 5 years, 38% of respondents changed their approach; of these, 70% lengthened the treatment course. Physician perceptions and strategies did not vary according to years of clinical experience. In conclusion, there is significant variability in practice and perceptions among pediatric nephrologists; however, most have extended therapy beyond the traditional 8-week course.