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
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.
['Yamamoto|Ryohei|R|', 'Imai|Enyu|E|', 'Maruyama|Shoichi|S|', 'Yokoyama|Hitoshi|H|', 'Sugiyama|Hitoshi|H|', 'Nitta|Kosaku|K|', 'Tsukamoto|Tatsuo|T|', 'Uchida|Shunya|S|', 'Takeda|Asami|A|', 'Sato|Toshinobu|T|', 'Wada|Takashi|T|', 'Hayashi|Hiroki|H|', 'Akai|Yasuhiro|Y|', 'Fukunaga|Megumu|M|', 'Tsuruya|Kazuhiko|K|', 'Masutani|Kosuke|K|', 'Konta|Tsuneo|T|', 'Shoji|Tatsuya|T|', 'Hiramatsu|Takeyuki|T|', 'Goto|Shunsuke|S|', 'Tamai|Hirofumi|H|', 'Nishio|Saori|S|', 'Shirasaki|Arimasa|A|', 'Nagai|Kojiro|K|', 'Yamagata|Kunihiro|K|', 'Hasegawa|Hajime|H|', 'Yasuda|Hidemo|H|', 'Ichida|Shizunori|S|', 'Naruse|Tomohiko|T|', 'Fukami|Kei|K|', 'Nishino|Tomoya|T|', 'Sobajima|Hiroshi|H|', 'Tanaka|Satoshi|S|', 'Akahori|Toshiyuki|T|', 'Ito|Takafumi|T|', 'Yoshio|Terada|T|', 'Katafuchi|Ritsuko|R|', 'Fujimoto|Shouichi|S|', 'Okada|Hirokazu|H|', 'Ishimura|Eiji|E|', 'Kazama|Junichiro James|JJ|', 'Hiromura|Keiju|K|', 'Mimura|Tetsushi|T|', 'Suzuki|Satashi|S|', 'Saka|Yosuke|Y|', 'Sofue|Tadashi|T|', 'Suzuki|Yusuke|Y|', 'Shibagaki|Yugo|Y|', 'Kitagawa|Kiyoki|K|', 'Morozumi|Kunio|K|', 'Fujita|Yoshiro|Y|', 'Mizutani|Makoto|M|', 'Shigematsu|Takashi|T|', 'Kashihara|Naoki|N|', 'Sato|Hiroshi|H|', 'Matsuo|Seiichi|S|', 'Narita|Ichiei|I|', 'Isaka|Yoshitaka|Y|']
D000328:Adult D000368:Aged D001706:Biopsy D015331:Cohort Studies D005260:Female D015433:Glomerulonephritis, Membranous D005923:Glomerulosclerosis, Focal Segmental D006801:Humans D007166:Immunosuppressive Agents D007668:Kidney D008297:Male D008875:Middle Aged D009402:Nephrosis, Lipoid D009404:Nephrotic Syndrome
Minimal change disease Membranous nephropathy Methylprednisolone Cyclosporine Focal and segmental glomerulosclerosis