scholarly journals POS-169 LEVAMISOLE IS A PROMISING ALTERNATE IMMUNOSUPPRESSIVE THERAPY IN FREQUENT RELAPSING AND STEROID DEPENDENT CHILDHOOD NEPHROTIC SYNDROME

2021 ◽  
Vol 6 (4) ◽  
pp. S69
Author(s):  
S.P. Yadav ◽  
J. Thakur
Keyword(s):  
Nephrotic Syndrome ◽  
Immunosuppressive Therapy ◽  
Childhood Nephrotic Syndrome ◽  
Steroid Dependent

scholarly journals Childhood Nephrotic Syndrome Management and Outcome: A Single Center Retrospective Analysis

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Chia-shi Wang ◽  
Jia Yan ◽  
Robert Palmer ◽  
James Bost ◽  
Mattie Feasel Wolf ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
High Morbidity ◽  
Metropolitan Statistical Area ◽  
Childhood Nephrotic Syndrome ◽  
Steroid Dependent ◽  
Increased Risk ◽  
Serious Disease

There is a paucity of information on outpatient management and risk factors for hospitalization and complications in childhood nephrotic syndrome (NS). We described the management, patient adherence, and inpatient and outpatient usage of 87 pediatric NS patients diagnosed between 2006 and 2012 in the Atlanta Metropolitan Statistical Area. Multivariable analyses were performed to examine the associations between patient characteristics and disease outcome. We found that 51% of the patients were treated with two or more immunosuppressants. Approximately half of the patients were noted to be nonadherent to medications and urine protein monitoring. The majority (71%) of patients were hospitalized at least once, with a median rate of 0.5 hospitalizations per patient year. Mean hospital length of stay was 4.0 (3.8) days. Fourteen percent of patients experienced at least one serious disease complication. Black race, frequently relapsing/steroid-dependent and steroid-resistant disease, and the first year following diagnosis were associated with higher hospitalization rates. The presence of comorbidities was associated with longer hospital length of stay and increased risk of serious disease complications. Our results highlight the high morbidity and burden of NS and point to particular patient subgroups that may be at increased risk for poor outcome.

scholarly journals Practice variations in the management of childhood nephrotic syndrome in the Netherlands

2021 ◽  
Author(s):  
Anne M. Schijvens ◽  
Lucie van der Weerd ◽  
Joanna A. E. van Wijk ◽  
Antonia H. M. Bouts ◽  
Mandy G. Keijzer-Veen ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
The Netherlands ◽  
Kidney Biopsy ◽  
Immunosuppressive Treatment ◽  
Pediatric Nephrology ◽  
Practice Variation ◽  
Childhood Nephrotic Syndrome ◽  
Steroid Dependent ◽  
Practice Variations ◽  
Steroid Sparing

AbstractNephrotic syndrome in childhood is a common entity in the field of pediatric nephrology. The optimal treatment of children with nephrotic syndrome is often debated. Previously conducted studies have shown significant variability in nephrotic syndrome management, especially in the choice of steroid-sparing drugs. In the Netherlands, a practice guideline on the management of childhood nephrotic syndrome has been available since 2010. The aim of this study was to identify practice variations and opportunities to improve clinical practice of childhood nephrotic syndrome in the Netherlands. A digital structured survey among Dutch pediatricians and pediatric nephrologists was performed, including questions regarding the initial treatment, relapse treatment, kidney biopsy, additional immunosuppressive treatment, and supportive care. Among the 51 responses, uniformity was seen in the management of a first presentation and first relapse. Wide variation was found in the tapering of steroids after alternate day dosing. Most pediatricians and pediatric nephrologists (83%) would perform a kidney biopsy in case of steroid-resistant nephrotic syndrome, whereas for frequent relapsing and steroid-dependent nephrotic syndrome this was 22% and 41%, respectively. Variation was reported in the steroid-sparing treatment. Finally, significant differences were present in the supportive treatment of nephrotic syndrome.Conclusion: Substantial variation was present in the management of nephrotic syndrome in the Netherlands. Differences were identified in steroid tapering, use of steroid coverage during stress, choice of steroid-sparing agents, and biopsy practice. To promote guideline adherence and reduce practice variation, factors driving this variation should be assessed and resolved. What is Known:• National and international guidelines are available to guide the management of childhood nephrotic syndrome.• Several aspects of the management of childhood nephrotic syndrome, including the choice of steroid-sparing drugs and biopsy practice, are controversial and often debated among physicians.What is New:• Significant practice variation is present in the management of childhood nephrotic syndrome in the Netherlands, especially in the treatment of FRNS, SDNS, and SRNS.• The recommendation on the steroid treatment of a first episode of nephrotic syndrome in the KDIGO guideline leaves room for interpretation and is likely the cause of substantial differences in steroid-tapering practices among Dutch pediatricians and pediatric nephrologists.

Immunosuppressive therapy in children with steroid dependent nephrotic syndrome. Review

2020 ◽  
Vol 22 (4) ◽  
pp. 474-489
Author(s):  
A.G. Agaronyan ◽  
◽  
T.V. Vashurina ◽  
O.V. Komarova ◽  
O.A. Zrobok ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Immunosuppressive Therapy ◽  
Steroid Dependent ◽  
Steroid Dependent Nephrotic Syndrome

A case of a 7-year-old boy with steroid-dependent nephrotic syndrome who developed severe neutropenia three months after the administration of rituximab

2009 ◽  
Vol 22 (2) ◽  
pp. 97-101 ◽  
Author(s):  
Ryugo Hiramoto ◽  
Shinsuke Matsumoto ◽  
Hironobu Eguchi ◽  
Yoshitaka Miyoshi ◽  
Isao Komori ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Severe Neutropenia ◽  
Steroid Dependent ◽  
Steroid Dependent Nephrotic Syndrome

scholarly journals Steroid treatment for the first episode of childhood nephrotic syndrome: comparison of the 8 and 12 weeks regimen using an individual patient data meta-analysis

2021 ◽  
Author(s):  
Anne M. Schijvens ◽  
Nynke Teeninga ◽  
Eiske M. Dorresteijn ◽  
Steven Teerenstra ◽  
Nicholas J. Webb ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Steroid Treatment ◽  
First Episode ◽  
Childhood Nephrotic Syndrome ◽  
Steroid Sensitive Nephrotic Syndrome ◽  
Steroid Sensitive ◽  
First Relapse ◽  
Steroid Regimen

AbstractSteroids are the cornerstone of the treatment of childhood nephrotic syndrome. The optimal duration for the first episode remains a matter of debate. The aim of this study is to determine whether the 8 weeks International Study of Kidney Disease in Children (ISKDC) regimen is equally effective as the 12 weeks steroid regimen from the German society of pediatric nephrology (Arbeitsgemeinschaft für Pädiatrische Nephrologie [APN]). An individual patient data (IPD) meta-analysis of randomized controlled trials reporting on prednisolone treatment for a first episode of childhood nephrotic syndrome was conducted. European trials aimed at investigating the ISKDC and/or APN steroid regimen were selected. The lead investigators of the selected trials were requested to provide the IPD of the specific treatment groups. Four trials included European cohorts using dosing schedules according to the regimens studied. IPD of two trials were available. A significant difference was found in time to first relapse after cessation of steroid treatment between the 8 and 12 weeks treatment group with a median time to relapse of 29 and 63 days, respectively. Moreover, relapse rate ratios during total follow-up were 51% higher for the 8 weeks regimen. Finally, younger children have a significantly lower time to first relapse and frequently relapsing nephrotic syndrome.Conclusions: The results of this IPD meta-analysis suggest that the 8 weeks steroid regimen for a first episode of steroid-sensitive nephrotic syndrome may not be equally effective as the 12 weeks steroid regimen. Moreover, this study highlights the importance of using uniform definitions to enable accurate comparison and interpretation of trial results.Trial registration: Registration number: CRD42020199244, date of registration 16-08-2020 What is Known:• Steroids are the cornerstone of the treatment of childhood nephrotic syndrome, however the optimal duration for the first episode remains a matter of debate.• Currently, the 8 weeks ISKDC protocol and 12 weeks APN protocol are among the most frequently used protocols in Europe. What is New:• The 8 weeks steroid regimen for a first episode of steroid-sensitive nephrotic syndrome may not be equally effective as the 12 weeks steroid regimen for the treatment of a first episode of nephrotic syndrome.• Younger children have a significantly shorter time to first relapse and time to frequent relapsing nephrotic syndrome.

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