An 8-year-old girl presents with facial puffiness, frothy urine, ascites, and bilateral leg edema for 2 weeks. Urinalysis shows 4+ proteinuria with no hematuria. Serum albumin is 1.6 g/dL, cholesterol 420 mg/dL. She is started on prednisolone 2 mg/kg/day. After 4 weeks of full-dose steroids, proteinuria persists 3+. What defines STEROID-RESISTANT nephrotic syndrome (SRNS)?
- A Persistent proteinuria (≥3+ or urine protein:creatinine >2) after 4 weeks of prednisolone 2 mg/kg/day (60 mg/m²/day) ✓
- B Persistent proteinuria after 4 weeks of prednisolone 1 mg/kg/day
- C Proteinuria recurring within 2 weeks of stopping steroids
- D Proteinuria persisting after 2 weeks of daily steroid therapy at any dose
Explanation
Steroid-resistant nephrotic syndrome (SRNS) is defined as failure to achieve complete remission (disappearance of proteinuria) after 4 weeks of prednisolone at standard dose of 2 mg/kg/day or 60 mg/m²/day (maximum 60 mg/day). Persistent proteinuria beyond 4 weeks of adequate steroid therapy defines SRNS. These children require renal biopsy (usually shows FSGS or mesangial proliferation) and alternative immunosuppressive agents (calcineurin inhibitors — cyclosporine/tacrolimus). Steroid-dependent NS = remission but relapse on dose reduction or within 2 weeks of stopping. Steroid-sensitive NS = remission within 4 weeks.
Reference: Ghai Essential Pediatrics, 10th ed.
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