Steroid pulse therapy using 500–1,000 mg/day (or 20–30 mg/kg/day) methylprednisolone (m-PSL) was performed using the following two major protocols; (1) three times over 3 consecutive weeks (47.8 %), and (2) three times every 2 months (18.9 %). The number of steroid pulses varied at each hospital (24 hospitals, once; 12 hospitals,

twice; find more 92 hospitals, three times). In total, 179 hospitals (80.2 %) did not change the protocol for each patient. Almost all facilities prescribed oral prednisolone after the steroid pulse therapy. A total of 141 hospitals (63.2 %) had criteria for tapering oral prednisolone. The most cited indication for the therapy was the histological findings (164 hospitals, 87.2 %), and other indications were proteinuria grade (156 hospitals, 83.0 %), disease activity (104 hospitals, 55.3 %), hematuria grade (56 hospitals, 29.8 %) and duration from onset (38 hospitals, 20.2 %). In addition, 109 hospitals (48.9 %) performed TSP if the patients wanted and the doctors judged to need the treatment. Figures 2 and 3 show the clinical remission rates for hematuria and proteinuria. The most frequent remission rate ranged from 60 to 80 %. Table 3 shows the routine examination before TSP, concomitant drugs and adverse effects. Fig. 1 Starting year for tonsillectomy and steroid pulse therapy (TSP). TSP spread rapidly in Japan from 2004 to 2008 Fig. 2 PI3K inhibitor Clinical remission rate for hematuria based on treatment. The clinical remission rate for

PTK6 hematuria in many hospitals using TSP was higher than that after steroid pulse without tonsillectomy or oral corticosteroid monotherapy

Fig. 3 Clinical remission rate of proteinuria based on the treatment. The clinical remission rate for proteinuria using TSP was higher than that using steroid pulse without tonsillectomy or oral corticosteroid monotherapy Steroid pulse therapy without tonsillectomy A total of 192 hospitals (51.1 %) performed steroid pulse therapy without tonsillectomy (Table 2). Most of the hospitals (183 hospitals, 95.3 %) performed steroid pulse therapy for less than 10 patients annually. Only six hospitals performed steroid pulse therapy for more than 11 patients per year. The main protocol of steroid pulse therapy was 500–1,000 mg/day m-PSL for 3 consecutive days. The number of times steroid pulses were varied among hospitals (34 hospitals, once; 31 hospitals twice; 65 hospitals, three times). The most cited indication for this therapy was histological findings and proteinuria grade (137 hospitals, 71.4 %), and other indications were disease activity (97 hospitals, 50.5 %), hematuria grade (30 hospitals; 15.6 %) and duration from onset (22 hospitals, 11.5 %). All hospitals prescribed oral prednisolone after the steroid pulse therapy. In total, 102 hospitals (53.1 %) had criteria for tapering oral prednisolone. Although the clinical remission rate for hematuria ranged between 60 and 80 % (Fig. 2), the remission rate for proteinuria was ranged between 0 and 20 % (Fig. 3).