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Year : 2021  |  Volume : 4  |  Issue : 2  |  Page : 67-81

Consensus guidelines on management of steroid resistant nephrotic syndrome

1 Department of Pediatric Nephrology, St. John's Medical College Hospital, Bengaluru, India
2 Department of Pediatrics, INHS Asvini, Mumbai, India
3 Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
4 Department of Pediatrics, Pediatric Nephrology Service, King Edward Memorial Hospital, Pune, India
5 Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
Arvind Bagga
Department of Pediatrics, Division of Nephrology, All India Institute of Medical Sciences, New Delhi - 110 029
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ajpn.ajpn_35_21

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Justification: The management of steroid-resistant nephrotic syndrome (SRNS) is challenging. These guidelines update existing 2009 Indian Society of Pediatric Nephrology recommendations on its management. Objective: To frame revised guidelines on diagnosis and evaluation, treatment and follow-up, and supportive care of patients with the illness. Process: The guidelines combine evidence-based recommendations and expert opinion. Formulation of key questions was followed by systematic review of literature, evaluation of evidence by experts, and two face-to-face meetings. Recommendations: Patients with SRNS should be managed under supervision of a pediatric nephrologist. Fourteen statements provide updated advice for defining steroid resistance, and underscore the importance of estimating proteinuria and baseline kidney function and the need for kidney biopsy and genetic screening. Calcineurin inhibitors are recommended as most effective in inducing remission of proteinuria, the chief factor associated with long-term renal survival. Advice on managing allograft recurrence, congenital nephrotic syndrome, and monitoring and supportive care, including the transition of care is described. This revised practice guideline is intended to improve management and patient outcomes and provide direction for future research.

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