A 5-year-old boy has his second episode of nephrotic syndrome (massive proteinuria, hypoalbuminaemia, oedema). He responded well to steroids (8-week course) during the first episode 6 months ago. Which statement about subsequent management is CORRECT according to standard paediatric nephrology practice?
- A Treat this relapse with full-dose prednisolone until remission, then taper; classify as steroid-sensitive nephrotic syndrome; frequent relapsers may then need cyclophosphamide or levamisole ✓
- B Immediately start cyclophosphamide as he is now classified as steroid-dependent
- C Perform a renal biopsy before starting steroids as a second episode indicates focal segmental glomerulosclerosis
- D Start tacrolimus immediately as this is now steroid-dependent nephrotic syndrome
Explanation
A single relapse does not classify a child as frequent relapser or steroid-dependent. The child should be treated with full-dose prednisolone (60 mg/m²/day) until 3 consecutive urine specimens are protein-free or trace, then tapered. Classification as frequent relapser requires ≥2 relapses in 6 months or ≥4 in 12 months; steroid-dependence requires relapses during taper or within 2 weeks of stopping. Cyclophosphamide, levamisole, or mycophenolate are reserved for frequent relapsers or steroid-dependent cases. Biopsy is not mandatory at this stage in a typical steroid-sensitive 5-year-old.
Reference: Ghai Essential Pediatrics, 10th ed.
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