Management of Steroid Sensitive Idiopathic Nephritic Syndrome in Children

Minimal change disease has become synonymous with steroid sensitive nephrotic syndrome as most of them achieve remission with corticosteroid therapy. Nephrotic syndrome is a common chronic disorder in children characterized by minimal change disease in majority. Despite being one of the most common renal conditions encountered in paediatric practice significant questions regarding treatment remain unanswered. Recent data from reviews shows that increased duration (3-6 months) of prednisolone compared with 2 months significantly reduced risk of relapse for the initial episode. Remission of proteinuria following corticosteroid therapy has greater prognostic value, in relation to long term outcome, then the precise renal histology. In relapsing SSNS prolong prednisolone treatment, daily prednisolone during infections, significantly reduced risk of relapse. Treatment with levamisole, cyclophosphamide, cyclosporine and mycophenolate mofetil is beneficial in valuable proportion of patients. Prospective trials are necessary to identify effective and safe therapies for frequently relapsing and steroid dependent patients.