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Nephrotic syndrome is the most common glomerular disorder in children, and corticosteroids are the first choice of treatment. While the majority of children respond to corticosteroid therapy, a few do not enter remission after daily therapy for 1-2 months, hence showing steroid-resistance. Unfortunately, there is no "one-size-fits-all" approach for precise patient stratification and treatment when facing the huge challenges posed by steroid-resistant nephrotic syndrome (srns). But genomic medicine has brought a glimmer of light, and the cognition of srns has entered a new stage. While steroids alone were sufficient for most patients with certain forms of nephrotic syndrome [ 2 ], it was clear that addition of other immunosuppressive agents demonstrated a better overall outcome in patients with other forms of gn, such as anti-glomerular basement membrane disease, lupus nephritis and focal necrotizing gn associated with small vessel vasculitis [ 8–12 ]. Steroid-resistant nephrotic syndrome (srns) in children carries a significant risk of progression to end-stage renal failure (esrf). We report a two-step protocol adapted in children with srns. Thirty-seven srns were treated with cyclosporine a (cya) in association with prednisolone (alternate day) for 6 months (first-step treatment). Rituximab also offers an alternative to current immunosuppressive therapies for difficult-to-treat nephrotic syndrome. Proportion of patients with steroid-dependent nephrotic syndrome at 12th month after 3 month standard treatment. Steroid-dependent nephrotic syndrome was defined as steroid-sensitive nephrotic syndrome with 2 or more consecutive relapses during tapering or within 14 days of stopping steroids. There is no cure for nephrotic syndrome, but your doctor might tell you to take certain medicines to treat the symptoms. And to keep the damage to your kidneys from getting worse. Medicine to control blood pressure and cholesterol can help prevent you from having a heart attack or a stroke. Medications given to treat nephrotic syndrome can also increase the risk of these infections. Other complications of nephrotic syndrome include hypothyroidism—a condition in which the thyroid gland does not produce enough thyroid hormone to meet the body’s needs. Treatment of severe steroid-dependent nephrotic syndrome (sdns) in children with tacrolimus. Nephrol dial transplant 2006; 21:1848. Wang w, xia y, mao j, et al. Treatment of tacrolimus or cyclosporine a in children with idiopathic nephrotic syndrome. Gulati a, sinha a, jordan sc, hari p, dinda ak, sharma s, et al. Efficacy and safety of treatment with rituximab for difficult steroid-resistant and -dependent nephrotic syndrome: multicentric report. Patients who do not show remission after 4 weeks' treatment with daily prednisolone are considered to have steroid-resistant nephrotic syndrome (srns). Renal histology in most patients shows presence of focal segmental glomerulosclerosis, minimal change disease, and (rarely) mesangioproliferative glomerulonephritis
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