A 4-year-old presents with bilateral eyelid puffiness, massive ascites, and frothy urine. Urinalysis shows 4+ protein (urine protein:creatinine ratio 4.2). Serum albumin is 1.8 g/dL. This is his first episode. The FIRST-LINE treatment is:
- A Prednisolone 2 mg/kg/day (maximum 60 mg/day) for 4–6 weeks ✓
- B Cyclophosphamide
- C Tacrolimus
- D Intravenous methylprednisolone pulse therapy
Correct answer: A. Prednisolone 2 mg/kg/day (maximum 60 mg/day) for 4–6 weeks
Explanation
Idiopathic nephrotic syndrome in children aged 1–8 years is most commonly due to minimal change disease (MCD), which responds to steroids in 90% of cases. Standard first-line treatment per ISKDC protocol is prednisolone 2 mg/kg/day (maximum 60 mg/day) for 4–6 weeks, followed by alternate-day dosing for 4–6 weeks. Cyclophosphamide and calcineurin inhibitors (tacrolimus, cyclosporine) are reserved for steroid-resistant or frequently relapsing nephrotic syndrome.
Reference: Ghai Essential Pediatrics, 10th ed.
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