Mr Thomas Veitch1, Mr Andrew Tan1, Prof Stephen Alexander2,3,4, Dr Diedre Hahn2,3,4, Dr Siah Kim2,3,5, Dr Hugh McCarthy2,3,4
1Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia, 2Department of Nephrology, Children’s Hospital at Westmead, Sydney, Australia, 3Centre for Kidney Research, Children’s Hospital at Westmead, Westmead, Australia, 4Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia, 5School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
Biography:
Tom Veitch is a final-year medical student at the University of Sydney, currently based at the Rural Clinical School in Orange, NSW. He has a strong interest in nephrology, particularly paediatric nephrology. He recently completed a two-month placement with the Freeman Hospital Nephrology Department in Northeast England, gaining experience in a broad range of renal conditions. This presentation is an extension of his medical school research project, completed under the supervision of Dr Hugh McCarthy at the Children’s Hospital at Westmead. He is keen to continue exploring opportunities in nephrology and academic medicine as he progresses in his training.
Background:
There is robust evidence guiding corticosteroid treatment at the initial onset of steroid sensitive nephrotic syndrome (SSNS), but almost no evidence around relapse treatment. This year the OPEN trial will compare standard versus low intensity steroid dosing but current local practice is not known.
Aims:
To quantify the variability and variation over time in practice amongst paediatric nephrologists in the Sydney Children’s Hospital Network (SCHN).
Methods:
A retrospective records review was conducted investigating treatments received by 173 children with SSNS within the SCHN. 100 first presentation treatments and 1004 relapses were categorised as either below standard, standard or above standard for each of the following treatment subgroups: First presentation dose and duration, relapse induction
dose and duration, relapse consolidation dose and duration.
Results:
173 children with SSNS were studied, with a mean age of 5.1 years, median length of follow up of 4.1 years and an average of 5.8 relapses each. The frequency of standard treatments increased by 5.3% per year when treating a first presentation of NS and by 3.3% when treating a relapse. Standard treatments were more common for first presentation when compared with relapse (63.3% vs 12.4%). While standard treatment of relapses became more common in recent years, treatment regimens did not vary significantly, with 4 of 27 possible permutations accounting for 67.7% of all relapse treatments.
Conclusion:
Steroid prescribing for first presentation of SSNS typically conformed to a standard regimen, but this was rarely true for treatment of relapses. Age, gender and site did not influence prescribing, but reverting to standard did become more common with time. The upcoming clinical trial will provide the necessary evidence to guide practice.
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