Advertisement

Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Applying decision analysis to management of adolescent idiopathic nephrotic syndrome

Abstract

Due to the concern that adolescents presenting with nephrotic syndrome are less likely to have minimal change disease than younger children, pediatric nephrologists have tended toward renal biopsy-tailored treatment rather than corticosteroid use in this population. The need for biopsy prior to treatment of nephrotic syndrome in adults has been challenged. A similar challenge to the clinical need for this procedure in adolescents with idiopathic nephrotic syndrome is raised here. The principles of medical decision analysis were applied and calculations were made with the Decision Maker computer program. The life expectancy of an adolescent who receives biopsytailored treatment was found to be no different from that of an adolescent who receives empiric corticosteroid treatment. We conclude that renal biopsy is not mandatory for the clinical management of adolescents with idiopathic nephrotic syndrome. Prognostically, a response, or lack thereof, to empiric corticosteroid therapy may be just as informative as a histological diagnosis.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Lau J, Levey AS, Kassirer JP, Pauker SG (1982) Idiopathic nephrotic syndrome in a 53-year-old women: is a kidney biopsy necessary? Med Decis Making 2: 497–519

  2. 2.

    Hlatky MA (1982) Is renal biopsy necessary in adults with nephrotic syndrome? Lancet II: 1264–1268

  3. 3.

    Kassirer JP (1983) Is renal biopsy necessary for optimal management of the idiopathic nephrotic syndrome? Kidney Int 24: 561–575

  4. 4.

    Levey AS, Lau J, Pauker SG, Kassirer JP (1987) Idiopathic nephrotic syndrome. Puncturing the biopsy myth. Ann Intern Med 107: 697–713

  5. 5.

    Beck JR, Pauker SG, Gottlieb JE, Klein K, Kassirer JP (1982) A convenient approximation of life expectancy (The “DEALE”). II. Use in medical decision-making. Am J Med 73: 889–897

  6. 6.

    Pauker SG, Kassirer JP (1981) Clinical decision analysis by personal computer. Arch Intern Med 141: 1831–1837

  7. 7.

    Lau J, Kassirer JP, Pauker SG (1983) Decision Maker 3.0: improved decision making by personal computer. Med Decis Making 3: 39–43

  8. 8.

    Kassirer JP (1976) The principles of clinical decision making: an introduction to decision analysis. Yale J Biol Med 49: 149–164

  9. 9.

    Collaborative Study of Adult Idiopathic Nephrotic Syndrome (1979) A controlled study of short-term prednisone treatment in adults with membranous nephropathy. N Engl J Med 301: 1302–1306

  10. 10.

    Glassock RJ (1992) Treatment of immunologically mediated glomerular disease. Kidney Int 42: S121-S126

  11. 11.

    International Study of Kidney Disease in Children (1978) Nephrotic syndrome in children: prediction of histopathology from clinical and laboratory characteristics at time of diagnosis. Kidney Int 13: 159–165

  12. 12.

    Barnett HL (1978) The natural and treatment history of glomerular diseases in children-what can we learn from international cooperative studies? A report of the International Study of Kidney Diseases in Children. Proceedings of the 6th International Congress of Nephrology. Karger, Basel, pp 470–485

  13. 13.

    Takada T, Yanagihara T, Kuwabara H, Hongoh K, Igarashi T, Yoshizumi A, Kihara I (1989) Clinicopathological study in 50 adolescent patients with nephrotic syndrome. Pediatr Nephrol 3: C9

  14. 14.

    Hogg RJ, Silva FG, Berry PL, Wenz JE (1993) Glomerular lesions in adolescents with gross hematuria or the nephrotic syndrome. Report of the Southwest Pediatric Nephrology Study Group. Pediatr Nephrol 7: 27–31

  15. 15.

    Chesney RW, Novello AC (1987) Forms of nephrotic syndrome more likely to progress to renal impairment. Pediatr Clin North Am 34: 609–627

  16. 16.

    Madaio MP (1990) Renal biopsy. Kidney Int 38: 529–543

  17. 17.

    United States Center for Health Statistics (1988) Vital Statistics of the United States. US Government Printing Office, Washington, D. C.

  18. 18.

    McCracken BH (1990) Genitourinary diseases. In: Lew EA, Gajewski J (eds) Medical risks: trends in mortality by age and time elapsed, vol 2. Praeger, New York

  19. 19.

    Johnson JP, McCauley CR, Copley JB (1982) The quality of life of hemodialysis and transplant patients. Kidney Int 22: 286–291

  20. 20.

    Evans RW, Manninen DL, Garrison LP Jr (1985) The quality of life in patients with end-stage renal disease. N Engl J Med 312: 553–559

  21. 21.

    Collan Y, Klockars M, Heino M (1978) Revision of light-microscopic kidney biopsy diagnosis in glomerular disease. Nephron 20: 24–31

  22. 22.

    White RHR, Glasgow EF, Mills RJ (1970) Clinicopathologic study of nephrotic syndrome in childhood. Lancet I: 1353–1359

  23. 23.

    Pauker SG, Kassirer JP (1987) Decision analysis. N Engl J Med 316: 250–257

  24. 24.

    McEnery PT, McAdams AJ, West CD (1986) The effect of prednisone in a high-dose, alternate-day regimen on the natural history of idiopathic membranoproliferative glomerulonephritis. Medicine (Baltimore) 64: 401–424

  25. 25.

    West CD (1992) Idiopathic membranoproliferative glomerulonephritis in childhood. Pediatr Nephrol 6: 96–103

  26. 26.

    Tarshish P, Bernstein J, Tobin JN, Edelman CM Jr (1992) Treatment of mesangiocapillary glomerulonephritis with alternate-day prednisone—a report of the International Study of Kidney Disease in Children. Pediatr Nephrol 6: 123–130

  27. 27.

    Habib R, Gubler MC, Gagnadoux MF, Niaudet P (1987) Recent advances in nephrotic syndrome in children. J Nephrol Repub China 1: 113–118

  28. 28.

    Gorry GA, Kassirer JP, Essig A, Schwartz WB (1973) Decision analysis as the basis for computer-aided management of acute renal failure. Am J Med 55: 473–484

  29. 29.

    Safran C, Tsichlis PN, Bluming AZ, Desforges JF (1977) Diagnostic planning using computer assisted decision-making for patients with Hodgkin's disease. Cancer 39: 2426–2434

  30. 30.

    Pauker SG (1976) Coronary artery surgery: the use of decision analysis. Ann Intern Med 85: 8–18

  31. 31.

    Barza M, Pauker SG (1980) The decision to biopsy, treat or wait in suspected herpes encephalitis. Ann Intern Med 92: 641–649

  32. 32.

    Magid D, Schwartz B, Craft J, Schwartz JS (1992) Prevention of Lyme disease after tick bites. N Engl J Med 327: 534–541

Download references

Author information

Correspondence to Marva M. Moxey-Mims.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Moxey-Mims, M.M., Stapleton, F.B. & Feld, L.G. Applying decision analysis to management of adolescent idiopathic nephrotic syndrome. Pediatr Nephrol 8, 660–664 (1994). https://doi.org/10.1007/BF00869080

Download citation

Key words

  • Adolescent
  • Nephrotic syndrome
  • Corticosteroids
  • Biopsy
  • Decision analysis