How is frequently relapsing nephrotic syndrome (FRNS) treated?

Updated: Mar 04, 2020
  • Author: Jerome C Lane, MD; Chief Editor: Craig B Langman, MD  more...
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The current KDIGO guidelines recommend that in FRNS and SDNS, prednisone be prescribed at 2 mg/kg/day (60 mg/m2/day) as a single morning dose until the patient has been free of proteinuria for at least 3 days. Following remission of proteinuria, prednisone is reduced to 1.5 mg/kg (40 mg/m2) given as a single dose on alternate days and tapered over 3 or more months. [63] A steroid-sparing agent, such as those listed below, can be considered once proteinuria is in remission.

With frequent courses of steroids or prolonged corticosteroid treatment, the risk of steroid toxicity is increased. Therefore, in FRNS and SDNS, the general practice is to change therapy to a steroid-sparing agent once remission of proteinuria has been achieved. Commonly used steroid-sparing agents are alkylating agents, calcineurin inhibitors, levamisole, mycophenolate mofetil, and rituximab.

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