Grand Rounds in Pediatric Nephrology – an ISN-IPNA Sister Centers initiative: A Challenging Case of Nephrotic Syndrome

Nephrotic syndrome refractory to standard treatment poses a challenging problem to paediatric nephrologists. Management issues involve many inter-dependent factors, including fluid status, kidney function, nutrition, infection and thrombosis risks. We will present a case of a child with primary nephrotic syndrome refractory to standard treatment. This session will address common management challenges of a nephrotic child, immunosuppressive strategies and general approach to genetic testing. 

Learning Objectives:

1. Outline definition of steroid resistant and multi drug resistant Nephrotic syndrome
2. Understand common challenges in managing the “difficult to treat” nephrotic state
3. Understand the factors to consider in selecting different immunosuppressive strategies
4. Understand approaches and pitfalls in genetic testing

Further Reading:

• Trautmann, A., Vivarelli, M., Samuel, S. et al. IPNA clinical practice recommendations for the diagnosis and management of children with steroid-resistant nephrotic syndrome. Pediatr Nephrol 35, 1529–1561 (2020). https://doi.org/10.1007/s00467-020-04519-1