Nephrotic syndrome
ICD-10 N04 · ICD-11 GB41

Nephrotic Syndrome: No Complete Remission by 6 Weeks Despite Glucocorticoid and RASi Therapy

Clinical Scenario

This protocol addresses steroid-resistant nephrotic syndrome (SRNS) — defined as the lack of complete remission within 4 weeks of daily prednisone or prednisolone at standard dose. In a child who does not achieve a complete response to glucocorticoids at 4 weeks, SRNS is diagnosed.

Prior Treatment — Escalation Trigger

The preceding treatment step involved initiating a renin-angiotensin system inhibitor (RASi), with a confirmation period that may include continued glucocorticoid treatment alongside methylprednisolone pulses.

This protocol is indicated when complete remission is not achieved by 6 weeks of that combined approach — the threshold that identifies a late non-responder and triggers escalation to second-line therapy.

Second-Line Approach

The established next step centres on a calcineurin inhibitor as initial second-line therapy, administered within a structured glucocorticoid co-treatment framework. The complete regimen — including choice of agent, accompanying medications, and the full management sequence — is available in the structured protocol.

Therapeutic target: Partial remission within 6 months and/or complete remission within 12 months.

Instant Access to Structured Evidence-Based Regimens

References

  1. SRNS: Lack of complete remission within 4 weeks of therapy with daily prednisone or prednisolone at standard dose
  2. In a child who does not achieve a complete response to glucocorticoids at 4 weeks, SRNS is diagnosed.
  3. We recommend using cyclosporine or tacrolimus as initial second-line therapy for children with steroid-resistant nephrotic syndrome.
  4. Calcineurin inhibitor-responsive SRNS: Partial remission with 6 months of treatment and/or complete remission with 12 months of treatment with a calcineurin inhibitor at adequate doses and/or levels
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