Frequently relapsing nephrotic syndrome in children: what to do when initial daily prednisone fails to achieve sustained remission

This protocol applies to children with nephrotic syndrome who experience a frequently relapsing course and have not achieved or maintained complete remission on the initial oral prednisone or prednisolone regimen.

Previous treatment — failure condition

The preceding line used oral prednisone or prednisolone given as a single daily dose, targeting complete remission defined as urine protein-free for at least 3 days. Failure to reach or sustain complete remission — in the setting of frequent relapsing disease — is the condition that escalates management to this next-line protocol.

Next-line approach (partial summary only)

The next step involves an alternate-day oral prednisone or prednisolone regimen structured specifically to prevent relapse. The full dose schedule, decision criteria, and complete algorithm are available via the link below.

Instant Access to Structured Evidence-Based Regimens

References

For children with frequently relapsing nephrotic syndrome without serious glucocorticoid-related adverse effects, low-dose, alternate-day oral prednisone/prednisolone (optimally ≤0.5 mg/kg per dose) can be prescribed to prevent relapse.

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