A 28-year-old woman presents with nephrotic syndrome (proteinuria 7 g/day, serum albumin 2.0 g/dL, peripheral oedema). Renal biopsy on electron microscopy shows diffuse effacement of podocyte foot processes with no immune deposits. Light microscopy shows no significant abnormality. What is the MOST appropriate first-line treatment?
- A Cyclosporine plus low-dose prednisolone
- B Mycophenolate mofetil as initial therapy
- C Oral prednisolone 1 mg/kg/day for 8–16 weeks ✓
- D Rituximab infusion as induction therapy
Correct answer: C. Oral prednisolone 1 mg/kg/day for 8–16 weeks
Explanation
The biopsy findings — diffuse podocyte foot process effacement, no immune deposits, normal light microscopy — are diagnostic of minimal change disease (MCD), the most common cause of nephrotic syndrome in adults aged 16–35. KDIGO 2021 guidelines recommend initial high-dose oral prednisolone (1 mg/kg/day, max 80 mg, or 2 mg/kg alternate day) for 8–16 weeks as first-line therapy; 80–90% of adults achieve complete remission. Cyclosporine or rituximab are used for frequently relapsing or steroid-dependent MCD.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.