Abstract
BackgroundNephrotic syndrome is the most common kidney disease in children worldwide. Our aim was to critically appraise the quality of recent Clinical Practice Guidelines (CPGs) for idiopathic steroid-sensitive nephrotic syndrome (SSNS) in children in addition to summarize and compare their recommendations.MethodsSystematic review of CPGs. We identified clinical questions and eligibility criteria and searched and screened for CPGs using bibliographic and CPG databases. Each included CPG was assessed by four independent appraisers using the Appraisal of Guidelines for REsearch & Evaluation II (AGREE-II) instrument. We summarized the recommendations in a comparison practical table.ResultsOur search retrieved 282 citations, of which three CPGs were eligible and appraised: Kidney Disease: Improving Global Outcomes (KDIGO) 2012, Japan Society for Pediatric Nephrology (JSPN) 2014, and American Academy of Pediatrics (AAP) 2009. Among these, the overall assessment of two evidence-based CPGs scored > 70% (KDIGO and JSPN), which was consistent with their higher scores in the six domains of the AGREE II Instrument. In domain 3 (rigor of development), KDIGO, JSPN, and AAP scored 84%, 74%, and 41%, respectively. In domain 5 (applicability), they scored 22%, 16%, and 19%, respectively, and in domain 6 (editorial independence), they scored 94%, 65%, and 88%, respectively.ConclusionsThe methodological quality of the KDIGO CPG was superior, followed by JSPN and AAP CPGs with the relevant recommendations for use in practice.Systematic review registrationThe protocol was registered in the Center for Open Science (OSF) DOI: 10.17605/OSF.IO/6QTMD and in the International prospective register of systematic reviews PROSPERO 2020 CRD42020197511.
Highlights
Nephrotic syndrome is the most common kidney disease in children worldwide
Systematic review registration: The protocol was registered in the Center for Open Science (OSF) DOI: 10.17605/ OSF.IO/6QTMD and in the International prospective register of systematic reviews PROSPERO 2020 CRD420201 97511
Identification of clinical practice guideline (CPG) for sensitive nephrotic syndrome (SSNS) in children We retrieved a total of 282 records
Summary
Nephrotic syndrome is the most common kidney disease in children worldwide. Our aim was to critically appraise the quality of recent Clinical Practice Guidelines (CPGs) for idiopathic steroid-sensitive nephrotic syndrome (SSNS) in children in addition to summarize and compare their recommendations. Nephrotic syndrome is considered the most common kidney disease in children worldwide. It is defined by a clinical characteristic of hypoalbuminemia < 25 g/L, edema and nephrotic range proteinuria > 40 mg/m2/h, or protein/creatinine ratio > 200 mg/mmol in a spot urine sample [1, 2]. There are many classifications of nephrotic syndrome: one of the classifications is based on the clinical response to steroids. Relapsing nephrotic syndrome (FRNS) is defined as two or more relapses in 6 months after the initial response or four and more relapses in any 1-year period [2]
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