A patient with nephrotic syndrome is prescribed high-dose prednisolone. After 8 weeks, there is no response. At what point is the patient classified as 'steroid-resistant' and what is the next appropriate step?

• A 4 weeks; add cyclophosphamide
• B 2 weeks; increase prednisolone dose to 2 mg/kg
• C 12 weeks; switch to dexamethasone pulse therapy
• D 8 weeks; perform renal biopsy and consider calcineurin inhibitors ✓

Explanation

In nephrotic syndrome, steroid resistance is defined as failure to achieve remission after 8 weeks of daily prednisolone at 60 mg/m2/day. At this point, renal biopsy is indicated and calcineurin inhibitors (cyclosporine or tacrolimus) are the standard next step. Continuing steroids beyond 8 weeks without response only increases toxicity without benefit.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.