An 8-year-old child with steroid-sensitive nephrotic syndrome has relapsed 4 times in the past 18 months and is currently on alternate-day prednisolone 0.5 mg/kg. The child develops Cushingoid features and poor growth. The MOST appropriate addition to minimize steroid toxicity while maintaining remission is:

• A Tacrolimus 0.1 mg/kg/day
• B Levamisole 2.5 mg/kg alternate day
• C Mycophenolate mofetil 600 mg/m2/day
• D Cyclophosphamide 2 mg/kg/day for 8 weeks ✓

Explanation

For frequently relapsing steroid-sensitive nephrotic syndrome (FRNS) with steroid toxicity, cyclophosphamide 2 mg/kg/day for 8–12 weeks is the most established steroid-sparing agent with long-term remission in approximately 50% of cases. Levamisole is an alternative first-line option but has lower durable remission rates. Tacrolimus and MMF are typically reserved for steroid-dependent FRNS unresponsive to cyclophosphamide. The total cumulative cyclophosphamide dose should not exceed 168 mg/kg to avoid gonadotoxicity.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.