A 5-year-old boy has massive proteinuria (urinary protein:creatinine ratio 8), hypoalbuminaemia (2.0 g/dL), oedema, and hyperlipidaemia. There is no haematuria and BP is normal. He is started on prednisolone 60 mg/m²/day. After 4 weeks of full-dose steroid therapy there is no remission. What defines 'steroid resistance' in nephrotic syndrome?
- A Failure to achieve remission after 8 weeks of full-dose prednisolone ✓
- B Failure to achieve remission after 4 weeks of full-dose prednisolone (60 mg/m²/day)
- C Two relapses within the first 6 months
- D Relapse during alternate-day steroid tapering
Explanation
Steroid-resistant nephrotic syndrome (SRNS) is defined as failure to achieve complete remission (urine protein trace or nil for 3 consecutive days) after 8 weeks of full-dose prednisolone (60 mg/m²/day or 2 mg/kg/day, maximum 60 mg/day, for 4 weeks) followed by 3 doses of IV methylprednisolone 1 g/m² (or by continued full-dose prednisolone for 4 more weeks by some protocols). Non-remission after 4 weeks alone is insufficient to label SRNS — the child needs the full 8-week protocol per ISKDC and IAP nephrology guidelines. Frequent relapsers relapse ≥4 times in 12 months. Steroid-dependent means relapse during or within 14 days of stopping steroids.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.