An 8-year-old child presents with periorbital edema, heavy proteinuria (5 g/day), hypoalbuminemia (1.8 g/dL), and hyperlipidemia. He is started on oral prednisolone. After 8 weeks of standard doses, he still has nephrotic-range proteinuria. This child is now classified as:
- A Steroid-dependent nephrotic syndrome
- B Steroid-resistant nephrotic syndrome — requires renal biopsy and consideration of calcineurin inhibitors ✓
- C Frequently relapsing nephrotic syndrome
- D Steroid-sensitive nephrotic syndrome in late remission
Correct answer: B. Steroid-resistant nephrotic syndrome — requires renal biopsy and consideration of calcineurin inhibitors
Explanation
Steroid-resistant nephrotic syndrome (SRNS) is defined as failure to achieve remission (complete: urine protein <4 mg/m²/hour) after 8 weeks of adequate prednisolone therapy (2 mg/kg/day for 4 weeks, then 1.5 mg/kg alternate-day for 4 weeks). SRNS warrants renal biopsy (often shows FSGS or MPGN rather than MCNS) and trial of calcineurin inhibitors (cyclosporine, tacrolimus) or mycophenolate mofetil. Steroid-dependent NS remits but relapses during steroid taper or within 2 weeks of stopping.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.