Induction prednisone dosing for childhood nephrotic syndrome: how low should we go?

Autor:	Trevor Kwok, Jennifer Sibley, Jasper J. Jöbsis, Abishek Roshan, Cherry Mammen, Alanoud Alshami, Marisa Catapang, Douglas G. Matsell, Matthew Sibley, Nonnie Polderman
Rok vydání:	2018
Předmět:	Male Nephrology medicine.medical_specialty Pediatrics Nephrotic Syndrome Time Factors Adolescent 030232 urology & nephrology 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Clinical pathway Recurrence Prednisone Internal medicine medicine Humans Minimal change disease Dosing Practice Patterns Physicians' Child Prospective cohort study Glucocorticoids Retrospective Studies British Columbia business.industry Remission Induction Infant Retrospective cohort study medicine.disease Proteinuria Treatment Outcome Child Preschool Pediatrics Perinatology and Child Health Critical Pathways Female business Nephrotic syndrome Follow-Up Studies medicine.drug
Zdroj:	Pediatric Nephrology. 33:1539-1545
ISSN:	1432-198X 0931-041X
DOI:	10.1007/s00467-018-3975-6
Popis:	Historically, children with nephrotic syndrome (NS) across British Columbia (BC), Canada have been cared for without formal standardization of induction prednisone dosing. We hypothesized that local historical practice variation in induction dosing was wide and that children treated with lower doses had worse relapsing outcomes.This retrospective cohort study included 92 NS patients from BC Children's Hospital (1990-2010). We excluded secondary causes of NS, age 1 year at diagnosis, steroid resistance, and incomplete induction due to early relapse. We explored cumulative induction dose and defined dosing quartiles. Relapsing outcomes above and below each quartile threshold were compared including total relapses in 2 years, time to first relapse, and proportions developing frequently relapsing NS (FRNS) or starting a steroid-sparing agent (SSA).Cumulative prednisone was widely distributed with approximated median, 1st, and 3rd quartile doses of 2500, 2000, and 3000 mg/mResults strongly justify our development of a standardized, province-wide NS clinical pathway to reduce practice variation and minimize under-treatment. The lowest induction prednisone dosing threshold to minimize future relapsing risks is likely between 2000 and 2500 mg/m
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::8024ce51c1e3be0c059e4cd3bad53ec5 https://doi.org/10.1007/s00467-018-3975-6 Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
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