Aditi Sinha1, Arvind Bagga2, Sushmita Banerjee3, Kirtisudha Mishra4, Amarjeet Mehta5, Indira Agarwal6, Susan Uthup7, Abhijeet Saha8, Om Prakash Mishra9. 1. Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India. 2. Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India. Correspondence to: Dr. Arvind Bagga, Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. arvindbagga@hotmail.com. 3. Department of Pediatrics, Institute of Child Health, Kolkata, India. 4. Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, Delhi, India. 5. Department of Pediatrics, Sawai Man Singh Medical College, Jaipur, India. 6. Department of Pediatrics, Christian Medical College, Vellore, India. 7. Department of Pediatrics, Trivandrum Medical College, Thiruvananthapuram, India. 8. Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India. 9. Department of Pediatrics, Institute of Medical Sciences, Benaras Hindu University, Varanasi, India.
Abstract
JUSTIFICATION: Steroid sensitive nephrotic syndrome (SSNS) is one of the most common chronic kidney diseases in children. These guidelines update the existing Indian Society of Pediatric Nephrology recommendations on its management. OBJECTIVE: To frame revised guidelines on diagnosis, evaluation, management and supportive care of patients with the illness. PROCESS: The guidelines combine evidence-based recommendations and expert opinion. Formulation of key questions was followed by review of literature and evaluation of evidence by experts in two face-to-face meetings. RECOMMENDATIONS: The initial statements provide advice for evaluation at onset and follow up and indications for kidney biopsy. Subsequent statements provide recommendations for management of the first episode of illness and of disease relapses. Recommendations on the use of immunosuppressive strategies in patients with frequent relapses and steroid dependence are accompanied by suggestions for step-wise approach and plan of monitoring. Guidance is also provided regarding the management of common complications including edema, hypovolemia and serious infections. Advice on immunization and transition of care is given. The revised guideline is intended to improve the management and outcomes of patients with SSNS, and provide directions for future research.
JUSTIFICATION: Steroid sensitive nephrotic syndrome (SSNS) is one of the most common chronic kidney diseases in children. These guidelines update the existing Indian Society of Pediatric Nephrology recommendations on its management. OBJECTIVE: To frame revised guidelines on diagnosis, evaluation, management and supportive care of patients with the illness. PROCESS: The guidelines combine evidence-based recommendations and expert opinion. Formulation of key questions was followed by review of literature and evaluation of evidence by experts in two face-to-face meetings. RECOMMENDATIONS: The initial statements provide advice for evaluation at onset and follow up and indications for kidney biopsy. Subsequent statements provide recommendations for management of the first episode of illness and of disease relapses. Recommendations on the use of immunosuppressive strategies in patients with frequent relapses and steroid dependence are accompanied by suggestions for step-wise approach and plan of monitoring. Guidance is also provided regarding the management of common complications including edema, hypovolemia and serious infections. Advice on immunization and transition of care is given. The revised guideline is intended to improve the management and outcomes of patients with SSNS, and provide directions for future research.
Authors: Khalid Alfakeekh; Mohammed Azar; Banan Al Sowailmi; Saja Alsulaiman; Salwa Al Makdob; Aamir Omair; Esam Albanyan; Manal Saleh Bawazeer Journal: J Infect Public Health Date: 2018-09-29 Impact factor: 3.718