Guidelines

Clinical practice guidelines relevant to Canadian paediatric nephrology, from CAPN and from the international societies.

International Pediatric Nephrology Association

IPNA develops clinical practice recommendations using the GRADE approach, and also endorses guidelines developed elsewhere. Its guidelines are grouped as prepared, endorsed and regional.

• IPNA guidelines

  The full index, with the standard operating procedure IPNA follows in developing a guideline.

• Steroid-sensitive nephrotic syndrome

  The second IPNA guideline on management of steroid-sensitive nephrotic syndrome in children, published in Pediatric Nephrology in 2022. A teaching slide set is available.

• Steroid-resistant nephrotic syndrome

  Recommendations for diagnosis and management, with translations available in fourteen languages.

Hypertension

• Hypertension Canada’s 2017 guidelines for paediatric hypertension

  Hypertension Canada has a long record of developing evidence-based guidance for primary care on blood pressure, and is likely part of the reason Canadian adults have among the best rates of treated hypertension in the world. Responding to requests for guidance on children, it formed a paediatric subgroup to review the literature systematically. Several CAPN members sat on that subcommittee, and every recommendation went through Hypertension Canada’s guideline process. The guideline is open access.

  • Graded recommendations for measuring blood pressure and diagnosing hypertension, and for investigating and treating it once confirmed.
  • A strong emphasis on health behaviour: healthy body weight, dietary management and increased physical activity.
  • Indications for pharmacological therapy, with initial options for children aged 12 and over with primary hypertension.
  • Clear indications for referral throughout, so that secondary hypertension is identified and managed by specialists, and so that primary care practitioners know when to hand over.

  Dionne JM, Harris KC, Benoit G, Feber J, Poirier L, Cloutier L, Nakhla M, Rabi D, Daskalopoulou SS, Fournier A, for the Hypertension Canada Guideline Committee. Hypertension Canada’s 2017 guidelines for the diagnosis, assessment, prevention, and treatment of pediatric hypertension. Can J Cardiol 2017;33:577–585.

• AAP clinical practice guideline on high blood pressure in children and adolescents, 2017

  The first comprehensive update in more than a decade, and the unofficial fifth report. It sets out 30 key action statements, each with its level of evidence and strength of recommendation, drawn from a review of nearly 15,000 papers. CAPN was one of the partner associations in its development, and it is open access.

  • A simplified screening table, based on the 90th percentile blood pressure at the 5th height percentile for each age and sex, so that whoever takes the first measurement can tell when the treating physician needs to review or repeat it.
  • Classification in adolescents aged 13 and over simplified to threshold values consistent with the adult ACC and AHA guidelines.
  • For children under 13, where percentiles still define hypertension, normative data revised to exclude children who were overweight or obese, so the reference population is a healthy one.
  • Investigation of confirmed hypertension clarified and simplified, given the high rates of primary hypertension.

  Flynn JT, Kaelber DC, Baker-Smith CM, et al, for the Subcommittee on Screening and Management of High Blood Pressure in Children. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 2017;140(3):e20171904.

Growth

• Human growth hormone guidelines in CKD

Guidelines change. If something here has been superseded, or a guideline your division relies on is missing, tell us at contact@capneph.ca.