A child comes with steroid resistant nephrotic syndrome secondary to FSGS, not responsive .to methylprednisolone. What next should be given ?
Ans is 'b' i.e., Oral cyclosporine o The treatment options for steroid resistant nephrotic syndrome are: (i) Calcineurin inhibitors (cyclosporine, Tacrolimus) (ii) IV or oral cyclophosphamide (iii) Levamisol (iv) Mycophenolate (v) Pulse coicosteroid o All above immunosuppressants are used along with coicosteriods (Prednisolone or methylprednisolone). o Cyclosporine and cyclophosphamide are most commonly used. o Despite these options, there is lack of consensus on first line appropriate therapy for steroid resistant nephrotic syndrome. o According to Indian Journal of pediatric (vol. 46, Jan 17, 2009) the efficacy of these durgs are (in decreasing order): Tacrolimus + Prednisolone > cyclosporine + Prednisolone > IV cyclophosphamide + Prednisolone > Pulse Corticosteroids (IV dexamethasone + oral cyclophosphamide + Prednisolne) > oral cyclophosphamide + PrednisoIon e. o So, amongst the given options, best answer is cyclosporine.
Oral cyclophosphamide
Oral cyclosporine
Oral mycophenolate
IV cyclophosphamide