A 52-year-old woman with focal segmental glomerulosclerosis and nephrotic syndrome is treated with high-dose prednisone for 6 months but fails to achieve remission. Which second-line agent, specifically approved for steroid-resistant FSGS and acting by inhibiting calcineurin, is recommended?
- A Mycophenolate mofetil
- B Cyclophosphamide
- C Tacrolimus or cyclosporine ✓
- D Rituximab
Explanation
For steroid-resistant FSGS (no response after 16 weeks of adequate corticosteroids), KDIGO guidelines recommend calcineurin inhibitors — cyclosporine or tacrolimus — as the preferred second-line agents. They achieve partial or complete remission in 40–60% of steroid-resistant FSGS by inhibiting calcineurin-mediated T-cell activation and may have direct podocyte-protective effects. Cyclosporine also stabilizes the actin cytoskeleton of podocytes. Mycophenolate and cyclophosphamide have lower efficacy. Rituximab's role in FSGS is primarily in recurrence after transplantation.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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