Nephrotic Syndrome — RACP Paediatrics MCQ

Instant feedback + full explanation. One question, done properly.

HardNephrologyNephrotic SyndromeRACP Paediatrics

A 5-year-old boy with nephrotic syndrome achieves remission on prednisolone but relapses 3 times in 6 months. He develops cushingoid features and growth deceleration. What is the most appropriate next-line steroid-sparing agent?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Mycophenolate mofetil (MMF)

For frequently relapsing or steroid-dependent nephrotic syndrome (FRNS/SDNS), steroid-sparing agents are recommended to reduce steroid toxicity. KDIGO 2025 and RCH guidelines recommend mycophenolate mofetil (MMF) or calcineurin inhibitors (cyclosporine/tacrolimus) as first-line steroid-sparing agents. Cyclophosphamide is used less commonly due to toxicity. Rituximab is reserved for refractory cases.

Reference: KDIGO – 2025 – Guideline for Nephrotic Syndrome in Children