Table 4.

Indications to glucocorticoids in GN

Indication	Details
Minimal change disease	In children, the first-line therapy rests on prednisone to be given as a single daily dose starting at 60 mg/m2 per day or 2 mg/kg per day to a maximum of 60 mg/d. This dosage should be given for at least 4 wk, followed by alternate-day administration starting at 40 mg/m2 to be continued for 2–5 mo. In adults, the initial dose is 1 mg/kg per day or 2 mg/kg every other day and should be given for at least 16 wk if complete remission is not achieved. In frequently relapsing/steroid-dependent patients mycopenolic acid salts, calcineurin inhibitors, and/or rituximab are frequently used.
Idiopathic FSGS	Patients should receive a minimum of 16 wk of glucocorticoid treatment. In patients who remit prednisone should be tapered off over 6 mo. Calcineurin inhibitors may be used in patients with poor tolerance or resistance to glucocorticoids. Focal glomerular sclerosis secondary to genetic, toxic, viral, or maladaptive causes should not be treated with glucocorticoids.
IgA nephropathy	For patients with an eGFR>50 ml/min per 1.73 m2 and proteinuria>1 g/d, a 6-mo glucocorticoid therapy can decrease proteinuria, reduce the deterioration of kidney function, and improve kidney survival. Patients with impaired kidney function should not be treated with steroid therapy or should receive lower doses of glucocorticoids.
Membranous nephropathy	There is no evidence that glucocorticoids alone may be of benefit. However, a cyclical treatment alternating glucocorticoids with an alkylating agent every other month for 6 mo may increase the number of remissions and protect kidney function in the long term. Low-dose glucocorticoids are also used to reinforce the efficacy of calcineurin inhibitors. Rituximab is also effective and well tolerated.
C3 glomerulopathy	Glucocorticoids alone are of little benefit. In combination with mycophenolate mofetil glucocorticoids may induce remission in C3 GN. Eculizumab can improve or stabilize kidney function in some patients.
Pauci-immune rapidly progressive GN	In the induction phase, intravenous high-dose glucocorticoids are strongly indicated and should be started as early as possible. Cyclophosphamide, rituximab, and/or plasmapheresis may also be used. Maintenance therapy rests on oral glucocorticoids associated with either mycophenolate or azathioprine.
Lupus nephritis	Intravenous methylprednisolone pulses, either alone or associated with rituximab, cyclophosphamide, or mycophenolate, are frequently used as a first therapy and for treating flares. Oral prednisone is used for maintenance therapy. Azathioprine, mycophenolate, or cyclosporine can allow the doses of prednisone to reduce.