A 5-year-old boy with nephrotic syndrome is started on prednisolone 60 mg/m2/day. He achieves complete remission (urine protein trace/nil) at week 4. He then develops two relapses within a 6-month period. The term for this relapse pattern and the most appropriate next step is:
- A Frequently relapsing — add levamisole or low-dose alternate day prednisolone ✓
- B Steroid-resistant — start cyclophosphamide
- C Steroid-dependent — switch to tacrolimus
- D Frequently relapsing — perform immediate renal biopsy
Correct answer: A. Frequently relapsing — add levamisole or low-dose alternate day prednisolone
Explanation
Frequently relapsing nephrotic syndrome is defined as ≥2 relapses within 6 months of initial response, or ≥4 relapses in any 12-month period. Management involves steroid-sparing agents: levamisole (immunomodulator, inexpensive, commonly used in India), low-dose alternate-day prednisolone, or alkylating agents (cyclophosphamide) for severe cases. Steroid-dependent syndrome (relapses during steroid taper) warrants calcineurin inhibitors (tacrolimus/cyclosporine). Renal biopsy is indicated for steroid resistance (no response at 8 weeks), not frequent relapsers.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.