An Update Review of Therapeutic Regimens for Steroid Resistant Idiopathic Nephrotic Syndrome

Idiopathic nephrotic syndrome is commonly seen in childhood between three months and 16 years of age, and const itutes 90% of all causes o f nephrot ic syndrome in childhood. It is defined as the association of nephrotic syndrome with minimal glomerular changes or nonspecific lesions, such as segmental and focal glomerular sclerosis or di ffuse mesangial p roliferat ion without any immune complex deposition. Steroid therapy is the first line of treatment in idiopathic nephrotic syndrome. The protocol from the International Study of Kidney Disease in Children (ISKDC) is widely adopted. The initial treatment for fi rst onset idiopathic nephro t ic syndrome wi th p redn isone at a dose o f 60 mg/m2/day in three divided doses or a maximum dose of 80 mg/day for four weeks, followed by 40 mg/m2 given in three consecutive days out of seven during the following four weeks.1 Therefore a to tal eigh t weeks of stero id therapy is most commonly used. About 90% of the children with idiopathic nephrotic syndrome respond to the steroid therapy. The remaining 10% who do not respond are labeled steroid resistant.