Treatment of steroid-resistant nephrotic syndrome.

Nephrotic syndrome is the most common glomerular disorder in children, and corticosteroids are the first choice of treatment. While the majority of children respond to corticosteroid therapy, a few do not enter remission after daily therapy for 1-2 months, hence showing steroid-resistance. Most of these children show focal and segmental glomerulosclerosis (FSGS) upon renal biopsy. Steroid resistance and associated complications make management of these patients very challenging, with their higher chance of progression to end-stage renal failure. Various immunosuppressive drugs have been used to induce remission with different success rates, though most of them have shown weak effectiveness. However, careful weighing of their toxic effects and effective dose should be done, especially when treating children with a non-malignant disease like nephrotic syndrome, thus obtaining optimum results. This review discusses steroid-resistant nephrotic syndrome and treatment strategies that have been attempted.