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The first randomized controlled trial in pediatric nephrology: the history of the International Study of Kidney Disease in Children (ISKDC)

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Abstract

The International Study of Kidney Disease in Children (ISKDC), begun in 1966, conducted the first international collaborative randomized blinded controlled trial in pediatric nephrology and one of the first in either pediatrics or nephrology. For this trial, the ISKDC developed the criteria, such as those for response and relapse, used today to describe the clinical course of the nephrotic syndrome, and the trial generated the nephropathologic terminology and criteria which largely remain the current standards. Over an approximately 20-year span, the ISKDC followed the natural history and evaluated the therapeutic effectiveness of therapies in over 500 children with the nephrotic syndrome from three continents. It published 14 peer-reviewed studies and several reports and commentaries, many of which helped create current standards of practice for therapy of childhood nephrotic syndrome and consequently remain highly cited today. The ISKDC continues to be an important model for subsequent collaborative studies and was the impetus for the development of regional and national pediatric nephrology societies leading to the recognition and growth of pediatric nephrology as a separate subspecialty.

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Acknowledgements

The authors very much appreciate the assistance of Mark Abramowicz, Anna Murphy, and Marie Claire Gubler in providing information on the original participant members of the ISKDC, Jochen Ehrich for his manuscript suggestions, and Connie Mackay for technical help.

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Authors and Affiliations

  1. University of North Carolina Kidney Center, Chapel Hill, NC, USA

    William A. Primack

  2. Department of Pediatrics, University of Virginia, Charlottesville, VA, USA

    Robert L. Chevalier & Victoria F. Norwood

  3. University of Minnesota, Minneapolis, MN, USA

    Aaron Friedman

  4. University of Southern California Keck School of Medicine, Los Angeles, CA, USA

    Kevin V. Lemley

  5. University of Rochester Medical Center, Rochester, NY, USA

    George J. Schwartz

  6. U.S. Food and Drug Administration, Silver Springs, MD, USA

    Douglas Silverstein

  7. Department of Pediatrics (Montefiore), Albert Einstein College of Medicine, Bronx, NY, USA

    Frederick Kaskel

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Contributions

All the authors contributed to the study conception and design. Material preparation, data collection, analysis, and visual abstract preparation were performed by William Primack and Frederick Kaskel. Victoria Norwood wrote the questions. The first draft of the manuscript was written by William Primack, and all authors commented and suggested revisions on previous versions of the manuscript. All authors approved the final manuscript.

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Kevin Lemley is an Associate Editor of Pediatric Nephrology.

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Primack, W.A., Chevalier, R.L., Friedman, A. et al. The first randomized controlled trial in pediatric nephrology: the history of the International Study of Kidney Disease in Children (ISKDC). Pediatr Nephrol 38, 3947–3954 (2023). https://doi.org/10.1007/s00467-022-05838-1

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