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First episode nephrotic syndrome — RACP Paediatrics MCQ

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HardNephrologyFirst episode nephrotic syndromeRACP Paediatrics

A 3-year-old has oedema, urine protein:creatinine ratio 420 mg/mmol and serum albumin 16 g/L. Blood pressure, creatinine and complement are normal; urine microscopy shows no haematuria. Which initial disease-modifying regimen best follows current Australian paediatric guidance?

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

Reveal the answer and explanation

Correct answer: B — Prednisolone 60 mg/m² daily for 4 weeks, then 40 mg/m² alternate-day for 4 weeks

Explanation lettering: E = shown as A · A = shown as B · B = shown as E

A is correct. This is a typical first presentation of childhood nephrotic syndrome; RCH uses prednisolone 60 mg/m² daily (maximum 60 mg) for four weeks, then 40 mg/m² on alternate days (maximum 40 mg) for four weeks. B incorrectly stops treatment according to early urine response. C omits the initial daily induction phase. D reserves a calcineurin inhibitor for selected steroid-resistant disease after nephrology assessment. E exposes a first-presentation, likely steroid-sensitive child to an alkylating agent without indication. Normal complement, renal function, blood pressure and urine microscopy make immediate biopsy unnecessary, but atypical features or failure to remit after four weeks require nephrology review.

Reference: Royal Children’s Hospital Melbourne: Nephrotic syndrome: https://www.rch.org.au/clinicalguide/guideline_index/nephrotic_syndrome/