Table 4.

Therapy procedures for adults (64,66,75)

First Episode of Nephrotic Syndromea

PDN 1 mg/kg per d or 2 mg/kg every other d (maximum 80 mg/d or 120 mg every other d) for 4–16 wk (evidence level 2C)

Taper slowly over a total period of up to 6 mo after achieving remissionb (evidence level 2D)

Infrequent relapses

PDN 1 mg/kg per d or 2 mg/kg every other d (maximum 80 mg/d or 120 mg every other d) for 4–16 wk (evidence level 2C)

Taper slowly over a total period of up to 6 mo after achieving remissionb (evidence level 2D)

Frequent relapses and steroid dependencyc

CPA 2–2.5 mg/kg per d for 8 wk (single course) (evidence level 2C)

If relapse occurs despite CPA or to preserve fertility:

CsA 3–5 mg/kg per d in two divided doses for 1–2 yr (evidence level 2C)

Or TAC 0.05–0.1 mg/kg per d in two divided doses until 3 mo after remission, then tapered to the minimum efficient dose for 1–2 yr (evidence level 2C)

If intolerant to PDN, CPA, and CsA or TAC:

MMF 500–1000 mg twice daily for 1–2 yr (evidence level 2D)

PDN, prednisone; CPA, cyclophosphamide; CsA, cyclosporine A; TAC, tacrolimus; MMF, mofetil mycophenolate.

^aDuring first episode, statins for hypercholesterolemia and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers for proteinuria in normotensive subjects are not indicated.

^bTaper by 5–10 mg/wk (it is preferable not to exceed a total maximum steroid exposure of 24 mo).

^cIn patients with frequently relapsing nephrotic syndrome or steroid-dependent nephrotic syndrome who develop steroid-related side effects (evidence level 1B).