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Minimal Change Disease — ESENeph MCQ

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ModerateGlomerulonephritisMinimal Change DiseaseESENeph

A 38-year-old woman presents with severe nephrotic syndrome (albumin 14 g/L, proteinuria 12 g/day). Kidney biopsy shows minimal change disease. She is started on Prednisolone 1 mg/kg/day. After 16 weeks, she has not achieved remission. What is the most appropriate next step?

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Correct answer: C — Ciclosporin

KDIGO 2021 GN guideline defines steroid-resistant MCD in adults as failure to achieve complete remission after 16 weeks of corticosteroids. For steroid-resistant MCD, calcineurin inhibitors (Ciclosporin or Tacrolimus) are recommended as first-line second agents. Rituximab is increasingly used in steroid-dependent or frequently relapsing MCD but has less evidence in steroid-resistant disease. Continuing high-dose steroids beyond 16 weeks increases toxicity without additional benefit.

Reference: KDIGO 2021 – Clinical Practice Guideline for Glomerular Diseases