Steroid Retrial After Rituximab and Mycophenolate Mofetil in Pediatric Refractory Nephrotic Syndrome

Abstract

Steroid-resistant nephrotic syndrome (SRNS) is a challenging condition. In pediatric SRNS, cyclosporine is the first-line treatment choice, with approximately 60% success rate. In cyclosporine-resistant disease, treatment modalities such as cyclophosphamide, mycophenolate mofetil (MMF), tacrolimus, vincristine, galactose, plasmapheresis and rituximab have been tried with variable success. In this paper, we report a patient with SRNS who remained resistant to all the above stated medications except a moderate response to rituximab. After rituximab, MMF re-initiation did not induce further improvement. Prednisone retrial thereafter induced a prompt remission. The significance of this finding in context with current literature has been discussed. World J Nephrol Urol. 2016;5(2):33-36 doi: http://dx.doi.org/10.14740/wjnu267w