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dc.contributor.authorFernández-Juárez, Gema
dc.contributor.authorVillacorta, Javier
dc.contributor.authorRuiz-Roso, Gloria
dc.contributor.authorPanizo, Nayara
dc.contributor.authorMartinez-Marín, Isabel
dc.contributor.authorMarco, Helena
dc.contributor.authorArrizabalaga, Pilar
dc.contributor.authorDíaz, Montserrat
dc.contributor.authorPerez-Gómez, Vanessa
dc.contributor.authorVaca, Marco
dc.contributor.authorRodríguez, Eva
dc.contributor.authorCobelo, Carmen
dc.contributor.authorFernandez, Loreto
dc.contributor.authorAvila, Ana
dc.contributor.authorPraga, Manuel
dc.contributor.authorQuereda, Carlos
dc.contributor.authorOrtiz Arduán, Alberto 
dc.contributor.otherUAM. Departamento de Medicinaes_ES
dc.contributor.otherInstituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD)es_ES
dc.date.accessioned2017-07-24T16:23:51Z
dc.date.available2017-07-24T16:23:51Z
dc.date.issued2016-01-01
dc.identifier.citationClinical Kidney Journal 9.3 (2016): 381–386en_US
dc.identifier.issn2048-8505 (print)es_ES
dc.identifier.issn2045-8513 (online)es_ES
dc.identifier.urihttp://hdl.handle.net/10486/679088
dc.description.abstractBackground: Variability in the management of glomerulonephritis may negatively impact efficacy and safety. However, there are little/no data on actual variability in the treatment of minimal change disease (MCD)/focal segmental glomerulosclerosis (FSGS) in adults.We assessed Spanish practice patterns for the management of adult nephrotic syndrome due to MCD or FSGS. The absence of reasonably good evidence on treatment for a disease often increases the variability substantially. Identification of evidence-practice gaps is the first necessary step in the knowledge-to-action cyclical process. We aim to analyse the real clinical practice in adults in hospitals in Spain and compare this with the recently released Kidney Disease: Improving Global Outcomes clinical practice guideline for glomerulonephritis. Methods: Participating centreswere required to include all adult patients (age > 18 years) with a biopsy-proven diagnosis ofMCD or FSGS from 2007 to 2011. Exclusion criteria included the diagnosis of secondary nephropathy. Results: We studied 119 Caucasian patients with biopsy-provenMCD(n = 71) or FSGS (n = 48) from13 Spanish hospitals. Of these patients, 102 received immunosuppressive treatment and 17 conservative treatment. The initial treatmentwas steroids, except in one patient in which mycophenolate mofetilwas used. In all patients, the steroidswere given as a single daily dose. The mean duration of steroid treatment at initial high doses was 8.7 ± 13.2 weeks and the mean global duration was 38 ± 32 weeks. The duration of initial high-dose steroidswas < 4weeks in 41% of patients and > 16weeks in 10.5% of patients.We did find aweak and negative correlation between the duration of whole steroid treatment in the first episode and the number of the later relapses (r = ?0.24, P = 0.023). There were 98 relapses and they were more frequent in MCD than in FSGs patients (2.10 ± 1.6 versus 1.56 ± 1.2; P = 0.09). The chosen treatment was mainly steroids (95%). Only seven relapses were treated with another drug as a first-line treatment: two relapses were treated with mycophenolate and five relapses were treated with anticalcineurinics. A second-line treatment was needed in 29 patients (24.4%), and the most frequent drugs were the calcineurin inhibitors (55%), followed by mycophenolate mofetil (31%). Although cyclophosphamide is the recommended treatment, itwas used in only 14% of the patients. Conclusions: We found variation from the guidelines in the duration of initial and tapered steroid therapy, in the medical criteria for classifying a steroid-resistant condition and in the chosen treatment for the second-line treatment. All nephrologists started with a daily dose of steroids as the first-line treatment. The most frequently used steroid-sparing drug was calcineurin inhibitors. Cyclophosphamide use was much lower than expected.en_US
dc.description.sponsorshipA.O. received ISCII and FEDER funds (FIS PI13/00047ISCIII-RETIC REDinREN RD12/0021), Programa Intensificación Actividad Investigadora (ISCIII/Agencia Laín-Entralgo/CM)en_US
dc.format.extent6 pag.es_ES
dc.format.mimetypeapplication/pdfen
dc.language.isoengen
dc.publisherOxford University Pressen_US
dc.relation.ispartofClinical Kidney Journalen_US
dc.rights© The Author 2016es_ES
dc.subject.otherClinical practice variabilityen_US
dc.subject.otherGlomerulonephritisen_US
dc.subject.otherImmunosuppressionen_US
dc.titleTherapeutic variability in adult minimal change disease and focal segmental glomerulosclerosisen_US
dc.typearticleen
dc.subject.ecienciaMedicinaes_ES
dc.relation.publisherversionhttps://doi.org/10.1093/ckj/sfw028es_ES
dc.identifier.doi10.1093/ckj/sfw028es_ES
dc.identifier.publicationfirstpage381es_ES
dc.identifier.publicationissue3es_ES
dc.identifier.publicationlastpage386es_ES
dc.identifier.publicationvolume9es_ES
dc.relation.projectIDGobierno de España. PI13/00047ISCIII-RETIC REDinRENes_ES
dc.type.versioninfo:eu-repo/semantics/publishedVersionen
dc.rights.ccReconocimiento – NoComerciales_ES
dc.rights.accessRightsopenAccessen
dc.facultadUAMFacultad de Medicina
dc.institutoUAMInstituto de Investigación Sanitaria Fundación Jiménez Díaz (ISS-FJD)


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