Steroid-Resistant Nephrotic Syndrome After Calcineurin Inhibitor Therapy Has Failed

This protocol addresses the management of nephrotic syndrome in patients who first failed to respond to standard-dose daily glucocorticoids and subsequently did not meet response targets on calcineurin inhibitor-based second-line therapy.

Clinical scenario — SRNS

Steroid-resistant nephrotic syndrome (SRNS) is defined as the lack of complete remission within 4 weeks of therapy with 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.

Previous treatment — failure condition

As initial second-line therapy, calcineurin inhibitor treatment (cyclosporine or tacrolimus) was administered for a minimum of 6 months. Escalation to this protocol is triggered when the required goals were not achieved: partial remission within 6 months and/or complete remission within 12 months.

Next-line approach

For calcineurin inhibitor-resistant disease, the structured protocol involves a B-cell depletion strategy using rituximab — the full criteria, schedule, and conditions of use are detailed in the complete protocol.

Instant Access to Structured Evidence-Based Regimens

References

SRNS: Lack of complete remission within 4 weeks of therapy with 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.
Where clinical trials are not available, there may be a limited role for treatment with rituximab.

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