A 4-year-old boy presents with bilateral periorbital puffiness, frothy urine, and abdominal distension. Investigations show: urine protein 4+ (>3.5 g/day), serum albumin 1.8 g/dL, serum cholesterol 420 mg/dL, and normal blood pressure. Renal biopsy shows effacement of foot processes on electron microscopy with no deposits on immunofluorescence. What is the TREATMENT of CHOICE?
- A Cyclophosphamide pulse therapy
- B Prednisolone 2 mg/kg/day for 4 weeks then alternate-day dosing ✓
- C ACE inhibitors alone
- D Rituximab as first-line agent
Correct answer: B. Prednisolone 2 mg/kg/day for 4 weeks then alternate-day dosing
Explanation
This presentation is classic nephrotic syndrome in a child, and the biopsy showing foot process effacement without deposits is Minimal Change Disease (MCD), the most common cause in children aged 1-8 years. MCD is steroid-sensitive in >90% of cases. The standard initial treatment per ISPN guidelines is prednisolone 2 mg/kg/day (max 60 mg) for 4 weeks, followed by 1.5 mg/kg on alternate days for 4 weeks. Cyclophosphamide and rituximab are reserved for steroid-resistant or frequently-relapsing disease.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.