A child comes with steroid resistant nephrotic syndrome

A child comes with steroid resistant nephrotic syndrome secondary to FSGS, not responsive to methylprednisolone. What next should be given –

    1. Oral cyclophosphamide
    1. Oral cyclosporine
    1. Oral mycophenolate
    1. IV cyclophosphamide

0 voters

ans:

  • The treatment options for steroid resistant nephrotic syndrome are:
  1. Calcineurin inhibitors (cyclosporine, Tacrolinzus)

  2. IV or oral cyclophosphamide
    Levamisol

  3. Mycophenolate

  4. Pulse corticosteroid

  • All above immunosuppressants are used along with corticosteroids (Prednisolone or methylprednisolone).
  • Cyclosporine and cyclophosphamide are most commonly used.
  • Despite these options, there is lack of consensus on first line appropriate therapy for steroid resistant nephrotic syndrome.
  • According to Indian Journal of pediatric (vol. 46, Jan 17, 2009) the efficacy of these drugs are (in decreasing order): Tacrolimus + Prednisolone > cyclosporine + Prednisolone > IV cyclophosphamide + Prednisolone > Pulse Corticosteroids (IV dexamethasone + oral cyclophosphamide + Prednisolne) > oral cyclophosphamide + Predniso-lone.
  • So, amongst the given options, best answer is cyclosporine.