A 4-year-old boy presents with periorbital puffiness, heavy proteinuria (>40 mg/m²/hr), hypoalbuminemia (1.8 g/dL), hyperlipidemia, and normal blood pressure. Renal biopsy (if performed) would most likely show minimal change on light microscopy with diffuse effacement of podocyte foot processes on electron microscopy. After 4 weeks of prednisolone (2 mg/kg/day), the child shows no response. Which of the following best describes 'steroid-resistant nephrotic syndrome' in children?

• A No remission after 4 weeks of daily prednisolone at 2 mg/kg/day ✓
• B No remission after 4 weeks of daily prednisolone followed by 3 doses of IV methylprednisolone
• C No remission after 8 weeks of standard prednisolone therapy (4 weeks daily + 4 weeks alternate day)
• D Relapse within 6 months of achieving initial remission

Explanation

Per ISKDC (International Study of Kidney Disease in Children) criteria, steroid-resistant nephrotic syndrome (SRNS) is defined as failure to achieve complete remission (protein-free urine) after 4 weeks of daily prednisolone at 2 mg/kg/day (maximum 60 mg/day). Some guidelines extend this to 8 weeks but the ISKDC/IPNA definition remains 4 weeks of daily therapy. Option C describes 8 weeks of treatment including alternate-day phase, which is the full initial course; failure at this point represents late steroid resistance. SRNS requires renal biopsy (often shows FSGS in older children) and treatment with calcineurin inhibitors (cyclosporin, tacrolimus). Option D describes frequently relapsing or steroid-dependent nephrotic syndrome.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.