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

Clin Exp Nephrol. 2019 Nov;23(11):1288-1297. doi: 10.1007/s10157-019-01772-z. Epub 2019 Aug 5.


Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

Keywords: Guideline-practice gap; Nephrotic syndrome; Practice patterns.

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Early Detection of Cancer
  • Glomerulonephritis, Membranous / drug therapy
  • Guideline Adherence / statistics & numerical data*
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Japan
  • Kidney Neoplasms / diagnosis*
  • Nephrology / standards
  • Nephrology / statistics & numerical data*
  • Nephrosis, Lipoid / drug therapy
  • Nephrotic Syndrome / drug therapy*
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Surveys and Questionnaires


  • Adrenal Cortex Hormones
  • Immunosuppressive Agents