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FSGS Steroid Response Duration — ESENeph MCQ

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ModerateGlomerulonephritisFSGS Steroid Response DurationESENeph

A 40-year-old man develops nephrotic syndrome. Biopsy shows focal segmental glomerulosclerosis (tip variant). Secondary causes are excluded. He starts Prednisolone 1 mg/kg/day. At 8 weeks, he has partial remission (proteinuria reduced from 8 g/day to 2 g/day). Should steroids be continued?

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Correct answer: B — Yes – continue steroids as partial response at 8 weeks warrants further treatment up to 16 weeks

KDIGO 2021 GN guideline recommends that high-dose glucocorticoids for primary FSGS should be continued for at least 4 weeks and up to 16 weeks. A partial response (>50% reduction in proteinuria) at 8 weeks is encouraging and warrants continued therapy. The tip variant of FSGS generally has the best prognosis and steroid responsiveness. Premature cessation of steroids at 8 weeks may result in relapse. CNIs are second-line for steroid-resistant disease, not for partial responders.

Reference: KDIGO 2021 – Glomerular Disease Guideline