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05.08.2019 | Original article | Ausgabe 11/2019

Clinical and Experimental Nephrology 11/2019

Variations in actual practice patterns and their deviations from the clinical practice guidelines for nephrotic syndrome in Japan: certified nephrologists’ questionnaire survey

Clinical and Experimental Nephrology > Ausgabe 11/2019
Kakuya Niihata, Hiroki Nishiwaki, Noriaki Kurita, Hirokazu Okada, Shoichi Maruyama, Ichiei Narita, Yugo Shibagaki, Izaya Nakaya
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s10157-019-01772-z) contains supplementary material, which is available to authorized users.
Kakuya Niihata and Hiroki Nishiwaki have contributed equally to this study.

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Few good-quality clinical trials on adults with nephrotic syndrome exist. Thus, there are discrepancies between real-world practice and clinical practice guidelines. We conducted a questionnaire-based survey to investigate potential discrepancies and the factors associated with variations in clinical practice.


A questionnaire was administered electronically to all board-certified nephrologists in Japan. To examine clinical practice variations in relation to physician characteristics, we estimated the ratio of the mean duration of steroid therapy using a generalized linear model, and the odds ratio of higher level ordinal variables using an ordered logistic regression model.


Responses of the 116 participants showed some variation for the majority of questions. Most participants (94.8%) indicated that screening for malignant tumors was “Conducted for almost all patients”. The duration of steroid therapy was found to be longer among physicians seeing ≥ 30 patients with nephrotic syndrome per month, both for minimal-change disease (ratio of mean 1.69; 95% CI 1.07–2.66) and membranous nephropathy (ratio of mean 1.71; 95% CI 1.09–2.69).


We identified practice patterns for nephrotic syndrome and discrepancies between clinical practice guidelines and actual practice. Defining the standard therapy for nephrotic syndrome may be necessary to generate high-quality evidence and develop clinical guidelines.

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