Regional variations in immunosuppressive therapy in patients with primary nephrotic syndrome: the Japan nephrotic syndrome cohort study

Background The lack of high-quality clinical evidences hindered broad consensus on optimal therapies for primary nephrotic syndromes. The aim of the present study was to compare prevalence of immunosuppressive drug use in patients with primary nephrotic syndrome across 6 regions in Japan. Methods Be...

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Published in:Clinical and experimental nephrology 2018-12, Vol.22 (6), p.1266-1280
Main Authors: Yamamoto, Ryohei, Imai, Enyu, Maruyama, Shoichi, Yokoyama, Hitoshi, Sugiyama, Hitoshi, Nitta, Kosaku, Tsukamoto, Tatsuo, Uchida, Shunya, Takeda, Asami, Sato, Toshinobu, Wada, Takashi, Hayashi, Hiroki, Akai, Yasuhiro, Fukunaga, Megumu, Tsuruya, Kazuhiko, Masutani, Kosuke, Konta, Tsuneo, Shoji, Tatsuya, Hiramatsu, Takeyuki, Goto, Shunsuke, Tamai, Hirofumi, Nishio, Saori, Shirasaki, Arimasa, Nagai, Kojiro, Yamagata, Kunihiro, Hasegawa, Hajime, Yasuda, Hidemo, Ichida, Shizunori, Naruse, Tomohiko, Fukami, Kei, Nishino, Tomoya, Sobajima, Hiroshi, Tanaka, Satoshi, Akahori, Toshiyuki, Ito, Takafumi, Yoshio, Terada, Katafuchi, Ritsuko, Fujimoto, Shouichi, Okada, Hirokazu, Ishimura, Eiji, Kazama, Junichiro James, Hiromura, Keiju, Mimura, Tetsushi, Suzuki, Satashi, Saka, Yosuke, Sofue, Tadashi, Suzuki, Yusuke, Shibagaki, Yugo, Kitagawa, Kiyoki, Morozumi, Kunio, Fujita, Yoshiro, Mizutani, Makoto, Shigematsu, Takashi, Kashihara, Naoki, Sato, Hiroshi, Matsuo, Seiichi, Narita, Ichiei, Isaka, Yoshitaka
Format: Article
Language:English
Subjects:
Adult
Aged
Biopsy
Cohort analysis
Cohort Studies
Cyclosporins
Female
Glomerulonephritis, Membranous - drug therapy
Glomerulosclerosis, Focal Segmental - drug therapy
Health risk assessment
Humans
Immunosuppressive agents
Immunosuppressive Agents - therapeutic use
Intravenous administration
Kidney - pathology
Kidney diseases
Male
Medicine
Medicine & Public Health
Membranous nephropathy
Methylprednisolone
Middle Aged
Nephrology
Nephropathy
Nephrosis, Lipoid - drug therapy
Nephrotic syndrome
Nephrotic Syndrome - drug therapy
Original Article
Regression analysis
Urology
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Summary:Background The lack of high-quality clinical evidences hindered broad consensus on optimal therapies for primary nephrotic syndromes. The aim of the present study was to compare prevalence of immunosuppressive drug use in patients with primary nephrotic syndrome across 6 regions in Japan. Methods Between 2009 and 2010, 380 patients with primary nephrotic syndrome in 56 hospitals were enrolled in a prospective cohort study [Japan Nephrotic Syndrome Cohort Study (JNSCS)], including 141, 151, and 38 adult patients with minimal change disease (MCD), membranous nephropathy (MN), and focal segmental glomerulosclerosis (FSGS), respectively. Their clinical characteristics were compared with those of patients registered in a large nationwide registry of kidney biopsies [Japan Renal Biopsy Registry (J-RBR)]. The regional prevalence of use of each immunosuppressive drug was assessed among adult MCD, MN, and FSGS patients who underwent immunosuppressive therapy in the JNSCS ( n  = 139, 127, and 34, respectively). Predictors of its use were identified using multivariable-adjusted logistic regression models. Results The clinical characteristics of JNSCS patients were comparable to those of J-RBR patients, suggesting that the JNSCS included the representatives in the J-RBR. The secondary major immunosuppressive drugs were intravenous methylprednisolone [ n  = 33 (24.6%), 24 (19.7%), and 9 (28.1%) in MCD, MN, and FSGS, respectively] and cyclosporine [ n  = 25 (18.7%), 62 (50.8%), and 16 (50.0%), respectively]. The region was identified as a significant predictor of use of intravenous methylprednisolone in MCD and MN patients. Conclusion Use of intravenous methylprednisolone for MCD and MN differed geographically in Japan. Its efficacy should be further evaluated in a well-designed trial.
ISSN:1342-1751
1437-7799
DOI:10.1007/s10157-018-1579-x