Abstract
Justification
The management of steroid resistant nephrotic syndrome (SRNS) is challenging. These guidelines update existing 2009 Indian Society of Pediatric Nephrology recommendations on its management.
Objective
To frame revised guidelines on diagnosis and evaluation, treatment and follow up, and supportive care of patients with the illness.
Process
The guidelines combine evidence-based recommendations and expert opinion. Formulation of key questions was followed by systematic review of literature, evaluation of evidence by experts and two face-to-face meetings.
Recommendations
Fourteen statements provide updated advice for managing steroid resistance, and underscore the importance of estimating proteinuria and baseline kidney function, and the need for kidney biopsy and genetic screening. Calcineurin inhibitors are recommended as most effective in inducing remission of proteinuria, the chief factor associated with long-term renal survival. Advice on managing allograft recurrence, congenital nephrotic syndrome, and monitoring and supportive care, including transition of care, are described. This revised practice guideline is intended to improve management and patient outcomes, and provide direction for future research.
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Supplementary material related to this study is available with the online version at www.indianpediatrics.net
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All authors involved in review of literature and preparation of background document; AV, RT, MM, JS, AS and AB drafted the manuscript; AB conceived the idea and critically revised the manuscript. All authors approved the final version of the manuscript.
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Indian Council of Medical Research; Advanced Centre for Research in Pediatric Kidney Diseases; 5/7/1090/2013-RHN; Department of Biotechnology, Government of India; BT/PR11030/MED/30/1644/2016.
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List of expert group members provided in Annexure I.
Kamran Afzal, Aligarh; Indira Agarwal, Vellore; Vinay Agarwal, New Delhi; Kanav Anand, New Delhi; M Ashraf, Srinagar; Arvind Bagga, New Delhi; Sushmita Banerjee, Kolkata; Girish C Bhatt, Bhopal; Sudha Ekambaram, Chennai; Arpita Gogoi, Dibrugarh; Sanjeev Gulati, New Delhi; Pankaj Hari, New Delhi; Suprita Kalra, New Delhi; Kanika Kapoor, New Delhi; Priyanka Khandelwal, New Delhi; Sriram Krishnamurthy, Puducherry; Manish Kumar, New Delhi; Mukta Mantan, New Delhi; Jitendra K Meena, New Delhi; Kirtisudha Mishra, New Delhi; Amarjeet Mehta, Jaipur; OP Mishra, Varanasi; Aliza Mittal, Jodhpur; Saroj K Patnaik, New Delhi; Subal Pradhan, Cuttack; PK Pruthi, New Delhi; Sumantra Raut, Kolkata; Abhijeet Saha, New Delhi; Manisha Sahay, Hyderabad; Jyoti Sharma, Pune; Shobha Sharma; New Delhi; Jyoti Singhal, Pune; Aditi Sinha, New Delhi; Rajiv Sinha, Kolkata; Ranjeet Thergaonkar, Mumbai; Karalanglin Tiewsoh, Chandigarh; Susan Uthup, Thiruvananthapuram; Anand S Vasudev, New Delhi; Anil Vasudevan, Bengaluru.
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Vasudevan, A., Thergaonkar, R., Mantan, M. et al. Consensus Guidelines on Management of Steroid-Resistant Nephrotic Syndrome. Indian Pediatr 58, 650–666 (2021). https://doi.org/10.1007/s13312-021-2262-y
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DOI: https://doi.org/10.1007/s13312-021-2262-y