CNI Taper FSGS Remission — ESENeph MCQ

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ModerateGlomerulonephritisCNI Taper FSGS RemissionESENeph

A 45-year-old man with nephrotic syndrome from primary FSGS has been treated with Prednisolone without response (steroid-resistant). He is now on Ciclosporin 5 mg/kg/day. After 6 months, he achieves partial remission (proteinuria reduced from 8 to 2.5 g/day). What is the recommended approach to Ciclosporin tapering?

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Correct answer: B — Continue the minimum effective dose, then taper slowly

KDIGO 2021 GN guideline recommends that if partial or complete remission is achieved with CNI therapy in FSGS, the CNI should be maintained at the minimum effective dose for at least 12 months before gradual tapering. Abrupt discontinuation is associated with high relapse rates (40-50%). Tapering should be slow (reduce by ~25% every 2-3 months). CNI nephrotoxicity monitoring (trough levels, eGFR) is essential throughout treatment. Some patients may need indefinite low-dose CNI to maintain remission. The competing options do not fit the renal phenotype, temporal relationship, treatment threshold or safety constraint described. Management still requires confirmation of current medicines, renal trajectory and relevant contraindications, followed by timely biochemical and clinical reassessment. Escalate urgently if life-threatening electrolyte disturbance, respiratory compromise, shock, neurological deterioration or a dialysis indication develops.

Reference: KDIGO 2021 – Glomerular Disease Guideline: https://kdigo.org/guidelines/gd/