Clinical Scenario:
A 6-year-old boy with steroid-sensitive nephrotic syndrome has experienced four relapses in the past 12 months despite responding completely to prednisolone each time. He is currently in remission but has developed cushingoid facies, excessive weight gain, and hypertension due to repeated steroid courses.
What is the most appropriate long-term management?
A. Cyclophosphamide
B. Levamisole
C. Mycophenolate mofetil
D. Prednisolone only during relapses
E. Rituximab
Correct answer & Explanation:
Correct answer : A. Cyclophosphamide
The child has frequently relapsing steroid-sensitive nephrotic syndrome (FRNS) with significant steroid toxicity. In such patients, a steroid-sparing agent is indicated. For a frequently relapsing child who is not steroid-dependent, cyclophosphamide is an appropriate first-line steroid-sparing agent because it can induce prolonged remission.
Learning Point:
Frequently relapsing nephrotic syndrome (FRNS): ≥2 relapses in 6 months or ≥4 relapses in 12 months.
Steroid-sparing agents include cyclophosphamide, levamisole, mycophenolate mofetil, calcineurin inhibitors, and rituximab, with the choice depending on relapse pattern, steroid dependence, and prior therapy.
