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Regional variations in immunosuppressive therapy in patients with primary nephrotic syndrome: the Japan nephrotic syndrome cohort study

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Abstract

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.

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Acknowledgements

This study was supported in part by a Grant-in-Aid for intractable Renal Diseases Research, Research on rare and intractable diseases, Health and Labour Sciences Research Grants for the Ministry of Health, Labor, and Welfare of Japan. JNSCS has been supported by a large number of investigator in 56 participating facilities (now 55 facilities because of a consolidation of two facilities); Hokkaido University Hospital, Sapporo, Hokkaido (Saori Nishio, Yasunobu Ishikawa, Daigo Nakazawa, and Tasuku Nakagaki); JCHO Sendai Hospital, Sendai, Miyagi (Toshinobu Sato, Mitsuhiro Sato, and Satoru Sanada); Tohoku University Hospital, Sendai, Miyagai (Hiroshi Sato, Mariko Miyazaki, Takashi Nakamichi, Tae Yamamoto, Kaori Narumi, and Gen Yamada); Yamagata University Hospital, Yamagata, Yamagata (Tsuneo Konta, and Kazuobu Ichikawa); Fukushima Medical University Hospital, Fukushima, Fukushima (Junichiro James Kazama, Tsuyoshi Watanabe, Koichi Asahi, Yuki Kusano, and Kimio Watanabe); University of Tsukuba Hospital, Tsukuba, Ibaraki (Kunihiro Yamagata, Joichi Usui, Shuzo Kaneko, and Tetsuya Kawamura); Gunma University Hospital, Maeashi, Gunma (Keiju Hiromura, Akito Maeshima, Yoriaki Kaneko, Hidekazu Ikeuchi, Toru Sakairi, and Masao Nakasatomi); Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama (Hajime Hasegawa, Takatsugu Iwashita, Taisuke Shimizu, Koichi Kanozawa, Tomonari Ogawa, Kaori Takayanagi, and Tetsuya Mitarai); Department of Nephrology, Saitama Medical University, Irumagun, Saitama (Hirokazu Okada, Tsutomu Inoue, Hiromichi Suzuki, and Kouji Tomori); Tokyo Women’s Medical University, Shinjuku-ku, Tokyo (Kosaku Nitta, Takahito Moriyama, Akemi Ino, and Masayo Sato); Teikyo University School of Medicine, Itabashi-ku, Tokyo (Shunya Uchida, Hideaki Nakajima, Hitoshi Homma, Nichito Nagura, Yoshifuru Tamura, Shigeru Shibata, and Yoshihide Fujigaki); Juntendo Faculty of Medicine, Bunkyo-ku, Tokyo (Yusuke Suzuki, Yukihiko Takeda, Isao Osawa, and Teruo Hidaka); St. Marianna University, Kawasaki, Kanagawa (Yugo Shibagaki, Sayuri Shirai, Daisuke Ichikawa, Tsutomu Sakurada, Tomo Suzuki, and Mikako Hisamichi); Niigata University Medical and Dental Hospital, Niigata, Niigata (Ichiei Narita, Naohumi Imai, Yumi Ito, Shin Goto, Yoshikatsu Kaneko, and Rhohei Kaseda); Kanazawa Medical University, Uchinada, Ishikawa (Hitoshi Yokoyama, Keiji Fujimoto, and Norifumi Hayashi); Kanazawa Univeristy Hospital, Kanazawa, Ishikawa (Takashi Wada, Miho Shimizu, Kengo Furuichi, Norihiko Sakai, Yasunori Iwata, Tadashi Toyama, and Shinji Kitajima); National Hospital Organization Kanazawa Medical Center, Kanazawa, Ishikawa (Kiyoki Kitagawa); Ogaki Municipal Hospital, Ogaki, Gifu (Hiroshi Sobajima, Norimi Ohashi, So Oshitani, and Kiyohito Kawashima); Gifu Prefectural Tajimi Hospital, Tajimi, Gifu (Tetsushi Mimura); Hamamatsu University Hospital, Hamamatsu, Shizuoka (Hidemo Yasuda, Akira Hishida, and Yoshihide Fujigaki); Shizuoka General Hospital, Shizuoka, Shizuoka (Satoshi Tanaka, and Noriko Mori); Chutoen General Medical Center, Kakegawa, Shizuoka (Toshiyuki Akahori, and Yutaka Fujita); Nagoya University Graduate School of Medicine, Nagoya, Aichi (Shoichi Maruyama, Naotake Tsuboi, Tomoki Kosugi, Takuji Ishimoto, Takayuki Katsuno, Noritoshi Kato, and Waichi Sato); Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi (Asami Takeda, Kunio Morozumi, Yasuhiro Ohtsuka, Hibiki Shinjo, and Akihito Tanaka); Fujita Health University School of Medicine, Toyoake, Aichi (Hiroki Hayashi, Yukio Yuzawa, Midori Hasegawa, Daijo Inaguma, Shigehisa Koide, and Kazuo Takahashi); Konan Kosei Hospital, Konan, Aichi (Takeyuki Hiramatsu, Shinji Furuta, and Hideaki Ishikawa); Anjo Kosei hospital, Anjo, Aichi (Hirofumi Tamai, and Takatoshi Morinaga); Ichinomiya Municipal Hospital, Ichinomiya, Aichi (Arimasa Shirasaki, Toshiki Kimura, and Mina Kato); Japanese Red Cross Nagoya Daiichi Hospital, Nagaoya, Aichi (Shizunori Ichida, and Nobuhide Endo); Kasugai Municipal Hospital, Kasugai, Aichi (Tomohiko Naruse, Yuzo Watanabe, and Yosuke Saka); Kainan hospital, Yatomi, Aichi (Satashi Suzuki, Michiko Yamazaki, and Rieko Morita); Masuko Memorial Hospital, Nagoya, Aichi (Kunio Morozumi, Kunio Morozumi, Kaoru Yasuda, Chika Kondo, Takahiro Morohiro, Rho Sato, and Yuichi Shirasawa); Chubu Rosai Hospital, Nagoya, Aichi (Yoshiro Fujita, Hideaki Shimizu, and Tatsuhito Tomino); Handa City Hospital, Handa, Aichi (Makoto Mizutani); Yokkaichi Municipal Hospital, Yokkaichi, Mie (Yosuke Saka, Hiroshi Nagaya, and Makoto Yamaguchi); Kitano Hospital, Osaka, Osaka (Tatsuo Tsukamoto, Eri Muso, Hiroyuki Suzuki, Tomomi Endo, and Hiroko Kakita); Toyonaka Municipal Hospital, Toyonaka, Osaka (Megumu Fukunaga); Osaka General Medical Center, Osaka, Osaka (Tatsuya Shoji, and Terumasa Hayashi); Osaka City University Hospital, Osaka, Osaka (Eiji Ishimura, Akihiro Tsuda, Shinya Nakatani, Ikue Kobayashi, Mitsuru Ichii, Akinobu Ochi, and Yoshiteru Ohno); Osaka Univeristy hospital, Suita, Osaka (Yoshitaka Isaka, Enyu Imai, Yasuyuki Nagasawa, Hirotsugu Iwatani, Ryohei Yamamoto, and Tomoko Namba); Kobe University hospital, Kobe, Hyogo (Shunsuke Goto MD, and Shinichi Nishi); Nara Medical University Hospital, Kashihara, Nara (Yasuhiro Akai, Ken-ichi Samejima, Masaru Matsui, Miho Tagawa, Kaori Tanabe, and Hideo Tsushima); Wakayama Medical University Hospital, Wakayama, Wakayama (Takashi Shigematsu MD, Masaki Ohya, Shigeo Negi, and Toru Mima); Shimane University Hospital, Izumo, Shimane (Takafumi Ito); Okayama Univeristy Hospital, Okayama, Okayama (Hitoshi Sugiyama, Keiko Tanaka, Toshio Yamanari, Masashi Kitagawa, Akifumi Onishi, and Koki Mise); Kawasaki Medical School, Kurashiki, Okayama (Naoki Kashihara, Tamaki Sasaki, Sohachi Fujimoto, and Hajime Nagasu); Graduate School of Medicine, The University of Tokushima,Tokushima,Tokushima (Kojiro Nagai, and Toshio Doi); Kagawa University, Miki-cho, Takamatsu, Japan (Tadashi Sofue, Hideyasu Kiyomoto, Kumiko Moriwaki, Taiga Hara, Yoko Nishijima, Yoshio Kushida, and Tetsuo Minamino); Kochi Medical School, Kochi University, Nankoku, Kochi (Terada Yoshio, Taro Horino, Yoshinori Taniguchi, Kosuke Inoue, Yoshiko Shimamura, and Tatsuki Matsumoto); Kyushu University Hospital, Fukuoka, Fukuoka (Kazuhiko Tsuruya, Hisako Yoshida, Naoki Haruyama, Shunsuke Yamada, Akihiro Tsuchimoto, and Yuta Matsukuma); Fukuoka University Hospital, Fukuoka, Fukuoka (Kosuke Masutani, Yasuhiro Abe, Aki Hamauchi, Tetsuhiko Yasuno, and Kenji Ito); Kurume University Hospital, Kurume, Fukuoka (Kei Fukami, Junko Yano, Chika Yoshida, Yuka Kurokawa, and Nao Nakamura); National Fukuoka Higashi Medical Center, Koga, Fukuoka (Ritsuko Katafuchi, Hiroshi Nagae, Shumei Matsueda, and Kazuto Abe); Nagasaki University Hospital, Nagasaki, Nagasaki (Tomoya Nishino, Tadashi Uramatsu, and Yoko Obata); Miyazaki University Hospital, Miyazaki, Miyazaki (Shouichi Fujimoto, Yuji Sato, Masao Kikuchi, Ryuzo Nishizono, Takashi Iwakiri, and Hiroyuki Komatsu). The register of patients with primary nephrotic syndrome in J-RBR between 2008 and 2011 was supported by many investigators in the following facilities: Asahikawa Medical University Hospital, Asahikawa, Hokkaido (Naoyuki Hasebe, Naoki Nakagawa, and Takayuki Okamoto); Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido (Saori Nishio); National Hospital Organization Hokkaido Medical Center, Sapporo, Hokkaido (Tomotsune Miyamoto and Masanori Ito); National Hospital Organization Hokkaido Medical Center, Sapporo, Hokkaido (Sekiya Shibazaki, Tomotsune Miyamoto, and Masanori Ito); Iwate Prefectural Central Hospital, Morioka, Iwate (Jun Soma, Izaya Nakaya, and Kazuhiro Yoshikawa); Yamagata University School of Medicine, Yamagata, Yamagata (Hiroshi Sato, Mariko Miyazaki, Takashi Nakamichi, Tae Yamamoto, Tsuneo Konta, and Kazunobu Ichikawa); Fukushima Medical University School of Medicine, Fukushima, Fukushima (Masaaki Nakayama, Koichi Asahi, and Hiroaki Satoh); Japan Community Health care Organization Sendai Hospital, Sendai, Miyagi (Toshinobu Sato, Asako Fujimori, Satoru Sanada, and Mitsuhiro Sato); Tohoku University Hospital and affiliated hospitals, Sendai, Miyagi (Hiroshi Sato, Mariko Miyazaki, Takashi Nakamichi, and Tae Yamamoto); Jichi Medical University, Shimotsuke, Tochigi (Daisuke Nagata, Shigeaki Muto, Osamu Saito, and Tetsu Akimoto); University of Tsukuba, Tsukuba, Ibaraki (Kunihiro Yamagata, Joichi Usui, and Tetsuya Kawamura); Mito Saiseikai General Hospital, Mito, Ibaraki (Itaru Ebihara and Chihiro Satho); Tokyo Medical University Ibaraki Medical Center, Inashiki, Ibaraki (Masaki Kobayashi, Kouichi Hirayama, and Homare Shimohata); Gunma University Graduate School of Medicine, Maebashi, Gunma (Keiju Hiromura, Yoriaki Kaneko, Hidekazu Ikeuchi, and Toru Sakairi); Saitama Medical University, Iruma, Saitama (Hirokazu Okada and Tsutomu Inoue); Saitama Medical University, Saitama Medical Center, Kwagoe, Saitama (Takatsugu Iwashita, Yuta Kogure, Kouichi Kanouzawa, and Hajime Hasegawa); National Hospital Organization Chiba-East Hospital (Hiroshi Kitamura, Toshiyuki Imazawa, Chieko Matsumura, and Naotake Akutsu, and Koichi Kamura); Showa University School of Medicine, Shinagawa-ku, Tokyo (Takanori Shibata); Tokyo Metropolitan Children’s Medical Center, Shinagawa-ku, Tokyo (Riku Hamada and Hiroshi Hataya); Nippon Medical School, Bunkyo-ku, Tokyo (Shuichi Tsuruoka, Yukinao Sakai, Akio Hirama, and Akiko Mii); Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo (Yusuke Suzuki, Miyuki Takagi, Hitoshi Suzuki, and Teruo Hidaka); Tokyo Women’s Medical University, Shinjuku-ku, Tokyo (Motoshi Hattori, Kenichiro Miura, Kiyonobu Ishizuka, Kosaku Nitta, Keiko Uchida, and Takahito Moriyama); Teikyo University School of Medicine, Itabashi-ku, Tokyo (Yoshihide Fujigaki); Nihon University School of Medicine, Itabashi-ku, Tokyo (Yoshinobu Fuke); The Jikei University School of Medicine, Minato-ku, Tokyo (Takashi Yokoo, Nobuo Tsuboi, and Kentaro Koike); The Jikei University School of Medicine, Daisan Hospital, Komae, Tokyo (Yoichi Miyazaki, Hiroyuki Ueda, Junichiro Kato, and Mai Tanaka); St. Marianna University School of Medicine, Kawasaki, Kanagawa (Tomo Suzuki, Daisuke Ichikawa, Sayuri Shirai, and Yugo Shibagaki); Yokohama City University Medical Center, Yokohama, Kanagawa (Nobuhito Hirawa, Sanae Saka, and Akira Fujiwara); Showa University Fujigaoka Hospital, Yokohama, Kanagawa (Yoshihiko Inoue); Niigata University Graduate School of Medical and Dental, NIigata, NIigata (Ichiei Narita, Shin Goto, Yumi Itoh, and Naofumi Imai); Toyama City Hospital, Toyama, Toyama (Satoshi Ota and Yoh-ichi Ishida); Toyama Prefectural Central Hospital, Toyama, Toyama (Masahiko Kawabata); Kanazawa Medical University School of Medicine, Kanazawa, Ishikawa (Hitoshi Yokoyama, Keiji Fujimoto, and Norifumi Hayashi); Pubulic Central Hospital of Matto-Ishikawa, Hakusan, Ishikawa (Kazuya Takasawa and Chikako Takaeda); National Hospital Organization Kanazawa Medical Center, Kanazawa, Ishikawa (Kiyoki Kitagawa); Kanazawa University Hospital, Kanazawa, Ishikawa (Takashi Wada, Kengo Furuichi, Miho Shimizu, and Norihiko Sakai); University of Fukui, Faculty of Medical Sciences, Yoshida, Fukui (Masayuki Iwano, Hideki Kimura, Naoki Takahashi, and Kenji Kasuno); Sugita Genpaku Memorial Obama Municipal Hospital, Obama, Fukui (Haruyoshi Yoshida and Takayasu Horiguchi); Shinshu University School of Medicine, Matsumoto, Nagano (Yuji Kamijo, Koji Hashimoto, Akinori Yamaguchi,, and Sonoda Kosuke); Fujinomiya City General Hospital, Fujinomiya, Shizuoka (Masanori Sakakima, Kazuto Kitajima, Taichi Sato, and Yutaro Kawakatsu); Hamamatsu University School of Medicine, University Hospital (Hideo Yasuda, Naro Ohashi, and Taichi Sato); Shizuoka General Hospital, Shizuoka, Shizuoka (Noriko Mori and Satoshi Tanaka); Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi (Asami Takeda and Yasuhiro Otsuka); Nagoya University Graduate School of Medicine, Nagoya, Aichi (Seiichi Matsuo, Shoichi Maruyama, and Yoshinari Yasuda); Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi (Michio Fukuda, Masashi Mizuno, Taisei Suzuki, and Satoru Kominato); Aichi Children’s Health and Medical Center, Obu, Aichi (Naoya Fujita, Satoshi Hibino, and Kazuki Tanaka); Fujita Health University School of Medicine, Toyoake, Aichi (Yukio Yuzawa, Hiroki Hayashi, and Kazuo Takahashi); Aichi Medical University School of Medicine, Nagakute, Aichi (Yasuhiko Ito, Takuhito Nagai, Takayuki Katsuno, and Hironobu Nobata); Mie University Graduate School of Medicine, Tsu, Mie (Eiji Ishikawa, Mika Fujimoto, Tomohiro Murata, and Masaaki Ito); Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Kyoto (Keiichi Tamagaki, Tetsuro Kusaba, and Yayoi Shiotsu); Kyoto University Graduate School of Medicine, Kyoto, Kyoto (Motoko Yanagita, Hideki Yokoi, Kaoru Sakai, and Akira Ishii); Osaka University Graduate School of Medicine, Suita, Osaka (Yoshitaka Isaka, Ryohei Yamamoto, and Tomoko Namba); Osaka General Medical Center, Osaka, Osaka (Terumasa Hayashi and Tatsuya Shoji); Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Osaka (Tatsuo Tsukamoto, Tomomi Endo, and Eri Muso); Osaka Red Cross Hospital, Osaka, Osaka (Akira Sugawara, Masao Koshikawa, Yoshihisa Ogawa, and Tomoko Kawanishi); Osaka City General Hospital, Osaka, Osaka (Rika Fujimaru); Osaka City University Graduate School of Medicine (Eiji Ishimura, Katsuhito Mori, Akihiro Tsuda, and Shinya Nakatani); Ikeda City Hospital, Ikeda, Osaka (Nobuyuki Kajiwara); Toyonaka Municipal Hospital, Toyonaka, Osaka (Megumu Fukunaga); Kobe University Graduate School of Medicine, Kobe, Hyogo (Shinichi Nishi and Shunske Goto); Nara Medical University, Kashihara, Nara (Kazuhiko Tsuruya and Kenichi Samejima); Wakayama Medical University, Wakayama, Wakayama (Takashi Shigematsu, Masaki Ohya, and Yuko Shima); Shimane University Faculty of Medicine, Izumo, Shimane (Takafumi Ito); Tottori University Faculty of Medicine, Yonago, Tottori (Shinichi Okada, Koichi Kitamoto, Hiroki Yokoyama, and Yuko Yamada); Kawasaki Medical School, Kurashiki, Okayama (Naoki Kashihara, Tamaki Sasaki, and Hajime Nagasu); Okayama Saiseikai General Hospital, Okayama, Okayama (Makoto Hiramatsu, Keisuke Maruyama, and Noriya Momoki); Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Okayama (Hiroshi Morinaga, Keiko Tanaka, and Ayu Akiyama); Hiroshima University Hospital, Hiroshima, Hiroshiam (Takao Masaki, Shigehiro Doi, Ayumu Nakashima, and Toshiki Doi); Saiseikai Yamaguchi General Hospital, Yamaguchi, Yamaguchi (Tsuyoshi Imai); Tokushima University Graduate School, Tokushima, Tokushima (Shoji Kagami, Maki Urushihara, and Yukiko Kinoshita); Kagawa University Faculty of Medicine, Kita, Kagawa (Tetsuo Minamino, Tadashi Sofue, Yoko Nishijima, and Yoshio Kushida); Kochi University, Kochi Medical School, Nangoku, Kochi (Mikiya Fujieda and Masayuki Ishihara); Kurume University School of Medicine, Kurume, Fukuoka (Kei Fukami and Jyunko Yano); University of Occupational and Environmental Health, Kitakyushu, Fukuoka (Masahito Tamura and Tetsu Miyamoto); National Fukuoka Higashi Medical Center, Koga, Fukuoka (Ritsuko Katafuchi); Japanese Red Cross Fukuoka Hospital, Fukuoka, Fukuoka (Ken Hatae, Manao Nishimura, and Hiroyo Maruyama); Fukuoka University Faculty of Medicine, Fukuoka, Fukuoka (Hitoshi Nakashima and Kosuke Masutani); Kyushu University School of Medicine, Fukuoka, Fukuoka (Toshiaki Nakano, Akihiro Tsuchimoto, Shunsuke Yamada, and Yuta Matsukuma); Nagasaki University Hospital, Nagasaki, Nagasaki (Takashi Taguchi, Tomoya Nishino, Hideyuki Arai, Yoko Obata, and Tadashi Uramatsu); Kumamoto University Graduate School of Medical Sciences, Kumamoto, Kumamoto (Masashi Mukoyama and Masataka Adachi); University of Miyazaki Hospital, Miyazaki, Miyazaki (Shouichi Fujimoto, Yuji Sato, Masao Kikuchi, and Akihiro Minakawa).

Author information

Authors and Affiliations

  1. Health and Counseling Center, Osaka University, 1-17 Machikaneyama-cho, Toyonaka, Osaka, 560-0043, Japan

    Ryohei Yamamoto

  2. Nakayamadera Imai Clinic, 2-8-18 Nakayamadera, Takarazuka, Hyogo, 665-0861, Japan

    Enyu Imai

  3. Department of Nephrology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan

    Shoichi Maruyama & Seiichi Matsuo

  4. Department of Nephrology, Kanazawa Medical Univeristy School of Medicine, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan

    Hitoshi Yokoyama

  5. Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kita-ku, Okayama, Okayama, 700-8558, Japan

    Hitoshi Sugiyama

  6. Department of Medicine, Kidney Center, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Kosaku Nitta

  7. Division of Nephrology and Dialysis, Kitano Hospital, Tazuke Kofukai Medical Research Institute, 2-4-20 Ogimachi, Kita-ku, Osaka, Osaka, 530-8480, Japan

    Tatsuo Tsukamoto

  8. Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8606, Japan

    Shunya Uchida

  9. Kidney Disease Center, Japanese Red Cross Nagoya Daini Hospital, 2-9 Myokencho, Showa-ku, Nagoya, Aichi, 466-8650, Japan

    Asami Takeda

  10. Department of Nephrology, JCHO Sendai Hospital, 3-16-1 Tsutsumi-machi, Aoba-ku, Sendai, Miyagi, 981-8501, Japan

    Toshinobu Sato

  11. Department of Nephrology and Laboratory Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan

    Takashi Wada

  12. Department of Nephrology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukakecho, Toyoake, Aichi, 470-1192, Japan

    Hiroki Hayashi

  13. First Department of Internal Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan

    Yasuhiro Akai

  14. Division of Nephrology, Department of Internal Medicine, Toyonaka Municipal Hospital, 4-14-1 Shibaharacho, Toyonaka, Osaka, 560-8565, Japan

    Megumu Fukunaga

  15. Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, 812-8582, Japan

    Kazuhiko Tsuruya

  16. Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, Fukuoka, 814-0180, Japan

    Kosuke Masutani

  17. Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2 Iida-Nishi, Yamagata-shi, Yamagata, Yamagata, 990-9585, Japan

    Tsuneo Konta

  18. Department of Kidney Disease and Hypertension, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, Osaka, Osaka, 558-8558, Japan

    Tatsuya Shoji

  19. Department of Nephrology, Konan Kosei Hospital, 137 Omatsubara, Takayacho, Konan, Aichi, 483-8704, Japan

    Takeyuki Hiramatsu

  20. Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, 7-5-1 Kusunokicho, Cuho-ku, Kobe, Hyogo, 650-0017, Japan

    Shunsuke Goto

  21. Department of Nephrology, Anjo Kosei hospital, 28 Higashihirokute, Anjocho, Anjo, Aichi, 446-8602, Japan

    Hirofumi Tamai

  22. Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan

    Saori Nishio

  23. Department of Nephrology, Ichinomiya Municipal Hospital, 2-2-22 Bunkyo, Ichinomiya, Aichi, 491-8558, Japan

    Arimasa Shirasaki

  24. Department of Nephrology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima, 770-8503, Japan

    Kojiro Nagai

  25. Department of Nephrology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan

    Kunihiro Yamagata

  26. Department of Nephrology and Hypertension, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-850, Japan

    Hajime Hasegawa

  27. Internal Medicine 1, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan

    Hidemo Yasuda

  28. Department of Nephrology, Japanese Red Cross Nagoya Daiichi Hospitail, 3-35 Michishitacho, Nakamura-ku, Nagoya, Aichi, 453-8511, Japan

    Shizunori Ichida

  29. Department of Nephrology, Kasugai Municipal Hospital, 1-1-1 Takakicho, Kasugai, Aichi, 486-8510, Japan

    Tomohiko Naruse

  30. Division of Nephrology, Department of Medicine, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka, 830-0011, Japan

    Kei Fukami

  31. Department of Nephrology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan

    Tomoya Nishino

  32. Department of Diabetology and Nephrology, Ogaki Municipal Hospital, 4-86 Minaminokawacho, Ogaki, Gifu, 503-8502, Japan

    Hiroshi Sobajima

  33. Department of Nephrology, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-ku, Shizuoka, Shizuoak, 420-8527, Japan

    Satoshi Tanaka

  34. Department of Nephrology, Chutoen General Medical Center, 1-1 Shobugaike, Kakegawa, Shizuoka, 436-8555, Japan

    Toshiyuki Akahori

  35. Division of Nephrology, Shimane University Hospital, 89-1 Enyacho, Izumo, Shimane, 693-8501, Japan

    Takafumi Ito

  36. Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kochi University, Okocho Kohasu, Nankoku, Kochi, 783-8505, Japan

    Terada Yoshio

  37. Kideny Unit, National Fukuoka Higashi Medical Center, 1-1-1 Chidori, Koga, Fukuoka, 811-3195, Japan

    Ritsuko Katafuchi

  38. Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotakecho, Miyazaki, Miyazaki, 889-1692, Japan

    Shouichi Fujimoto

  39. Department of Nephrology, Saitama Medical University, 38 Morohongo, Moroyama, Iruma, Saitama, 350-0495, Japan

    Hirokazu Okada

  40. Department of Nephrology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan

    Eiji Ishimura

  41. Department of Nephrology and Hypertension, Fukushima Medical University School of Medicine, 1 Hikariga-oka, Fukushima-city, Fukushima, 960-1295, Japan

    Junichiro James Kazama

  42. Department of Nephrology and Rheumatology, Gunma University Graduate School of Medicine, 3-39-22 Showa-matchi, Maebashi, Gunma, 371-8511, Japan

    Keiju Hiromura

  43. Department of Nephrology, Gifu Prefectural Tajimi Hospital, 5-161 Maebatacho, Tajimi, Gifu, 507-8522, Japan

    Tetsushi Mimura

  44. Department of Nephrology, Kainan Hospital, 396 Minamihonden, Maegasucho, Yatomi, Aichi, 498-8502, Japan

    Satashi Suzuki

  45. Department of Nephrology, Yokkaichi Municipal Hospital, Yokkaichi, 2-2-37 Shibata, Yokkaichi, Mie, 510-8567, Japan

    Yosuke Saka

  46. Department of Cardiorenal and Cerebrovascular Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan

    Tadashi Sofue

  47. Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan

    Yusuke Suzuki

  48. Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-000, Japan

    Yugo Shibagaki

  49. Division of Internal Medicine, National Hospital Organization Kanazawa Medical Center, 1-1 Shimoishibikimachi, Kanazawa, Ishikawa, 920-8650, Japan

    Kiyoki Kitagawa

  50. Department of Nephrology, Masuko Memorial Hospital, 35-28 Takegashicho, Nakamura-ku, Nagoya, Aichi, 453-0016, Japan

    Kunio Morozumi

  51. Department of Nephrology, Chubu Rosai Hospital, 1-10-6 Komei, Minato-ku, Nagoya, Aichi, 455-8530, Japan

    Yoshiro Fujita

  52. Department of Nephrology, Handa City Hospital, 2-29 Toyocho, Handa, Aichi, 475-8599, Japan

    Makoto Mizutani

  53. Department of Nephrology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8509, Japan

    Takashi Shigematsu

  54. Department of Nephrology and Hypertension, Kawasaki Medical School, 577 Matsushima, Kurashiki, Osakayama, 701-0192, Japan

    Naoki Kashihara

  55. Department of Nephrology, Endocrinology, and Vascular Medicine, Tohoku Univeristy Gradaute School of Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai, Miyagi, 980-8574, Japan

    Hiroshi Sato

  56. Division of Clinical Nephrology and Rheumatology, Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences, 757 Ichibancho, Asahimachi-dori, Chuo Ward, Niigata, Niigata, 951-8510, Japan

    Ichiei Narita

  57. Department of Nephrology, Osaka University Graduate School of Medicine, 2-2-D11 Yamadaoka, Suita, Osaka, 565-0871, Japan

    Yoshitaka Isaka

Authors
  1. Ryohei Yamamoto
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  2. Enyu Imai
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  3. Shoichi Maruyama
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  4. Hitoshi Yokoyama
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  5. Hitoshi Sugiyama
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  6. Kosaku Nitta
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  7. Tatsuo Tsukamoto
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  11. Takashi Wada
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  13. Yasuhiro Akai
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  14. Megumu Fukunaga
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  15. Kazuhiko Tsuruya
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  16. Kosuke Masutani
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  18. Tatsuya Shoji
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  22. Saori Nishio
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  26. Hajime Hasegawa
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  29. Tomohiko Naruse
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  30. Kei Fukami
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  31. Tomoya Nishino
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  32. Hiroshi Sobajima
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  33. Satoshi Tanaka
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  35. Takafumi Ito
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  38. Shouichi Fujimoto
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  46. Tadashi Sofue
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  47. Yusuke Suzuki
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  50. Kunio Morozumi
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  51. Yoshiro Fujita
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  55. Hiroshi Sato
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  56. Seiichi Matsuo
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  57. Ichiei Narita
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  58. Yoshitaka Isaka
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Corresponding author

Correspondence to Yoshitaka Isaka.

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Conflict of interest

The authors have declared that no conflict of interest exists.

Ethical approval

All procedures performed in J-RBR and JNSCS involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (IRB approval number 061171, 08212, and 13134 at the ethics committee of Osaka University Hospital) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in J-RBR and JNSCS.

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Yamamoto, R., Imai, E., Maruyama, S. et al. Regional variations in immunosuppressive therapy in patients with primary nephrotic syndrome: the Japan nephrotic syndrome cohort study. Clin Exp Nephrol 22, 1266–1280 (2018). https://doi.org/10.1007/s10157-018-1579-x

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  • DOI: https://doi.org/10.1007/s10157-018-1579-x

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