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Frequently Relapsing MCD — ESENeph MCQ

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ModerateGlomerulonephritisFrequently Relapsing MCDESENeph

A 28-year-old woman presents with sudden-onset nephrotic syndrome. Kidney biopsy shows diffuse podocyte foot process effacement on EM with no deposits on IF and normal light microscopy. She responds completely to Prednisolone within 4 weeks. Over the next 2 years she has 4 relapses, each requiring steroids. What is the most appropriate steroid-sparing agent?

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Correct answer: C — Rituximab

This is frequently relapsing minimal change disease. KDIGO 2021 GN guideline recommends that for adults with frequently relapsing or steroid-dependent MCD, Rituximab, Cyclophosphamide, or CNIs (Ciclosporin/Tacrolimus) are second-line options. Recent evidence (MAINTRUST trial and others) strongly supports Rituximab as a highly effective steroid-sparing agent with a favourable safety profile compared to Cyclophosphamide (gonadotoxicity, malignancy risk) and CNIs (nephrotoxicity, relapse on withdrawal).

Reference: KDIGO 2021 – Glomerular Disease Guideline; Ravani et al 2020 – Rituximab in MCD