A 6-year-old boy with steroid-responsive nephrotic syndrome relapses frequently. Which statement about the treatment of frequently relapsing nephrotic syndrome is correct?

• A Rituximab is contraindicated in children
• B Cyclophosphamide is given for 12 months
• C Mycophenolate mofetil is the first-line steroid-sparing agent
• D Levamisole is used as a steroid-sparing agent ✓

Explanation

Levamisone (levamisole) is used as a steroid-sparing agent in frequently relapsing nephrotic syndrome, typically given on alternate days. Cyclophosphamide is given for 8-12 weeks, not 12 months. Mycophenolate is used but cyclophosphamide is preferred for frequent relapsers. Rituximab is increasingly used in steroid-dependent and frequently relapsing nephrotic syndrome and is not contraindicated.

Reference: KDIGO Clinical Practice Guideline for Glomerulonephritis, 2021 (Update) ed.

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