Standard first-line treatment for minimal change disease centres on glucocorticoids. For patients in whom glucocorticoids carry meaningful risk, an evidence-based alternative initial approach is required.
This protocol applies when at least one of the following relative contraindications is present:
Management in this setting is built around glucocorticoid-sparing initial therapy. One of several established immunosuppressive alternatives is chosen according to the patient's individual risk profile and comorbidities.
The primary clinical objective is induction of complete remission of nephrotic syndrome.
For patients in whom glucocorticoids may be relatively contraindicated, consider initial therapy with cyclophosphamide, a CNI, or MMF.
These treatments are considered in patients who have relative contraindications (severe hyperglycemia, preexisting osteoporosis or osteopenia, or glucocorticoid-induced psychosis) or are unwilling to take glucocorticoids.
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