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 ri sk of relapse. A questionnaire was mailed to 130 pediatric nephrologists in the United States and Canada. One hundred and five (81%) replied. Of the r espondents, 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 remis sion (14%) or used another regimen (15%). Physicians using the 12-week regi men 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 previ ous 5 years, 38% of respondents changed their approach; of these. 70% lengt hened the treatment course. Physician perceptions and strategies did not va ry according to years of clinical experience. In conclusion, there is signi ficant variability in practice and perceptions among pediatric nephrologist s; however, most have extended therapy beyond the traditional 8-week course .