A child comes with steroid-resistant nephrotic syndrome secondary to FSGS, not responsive to methylprednisolone. What next should be given –

The treatment options for steroid-resistant nephrotic syndrome are: Calcineurin inhibitors (cyclosporine, Tacrolinzus) IV or oral cyclophosphamide Levamisol Mycophenolate Pulse corticosteroid All above immunosuppressants are used along with corticosteroids (Prednisolone or methylprednisolone). Cyclosporine and cyclophosphamide are most commonly used. Despite these options, there is a lack of consensus on first line appropriate therapy for steroid-resistant nephrotic syndrome. According to Indian Journal of pediatric (vol. 46, Jan 17, 2009) the efficacy of these drugs are (in decreasing order): Tacrolimus + Prednisolone > cyclosporine + Prednisolone > IV cyclophosphamide + Prednisolone > Pulse Corticosteroids (IV dexamethasone + oral cyclophosphamide + Prednisolne) > oral cyclophosphamide + Predniso-lone. So, amongst the given options, best answer is cyclosporine.