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. 2021 Mar 20;58(5):461–481. doi: 10.1007/s13312-021-2217-3

Steroid Sensitive Nephrotic Syndrome: Revised Guidelines

Aditi Sinha 1, Arvind Bagga 1,✉, Sushmita Banerjee 2, Kirtisudha Mishra 3, Amarjeet Mehta 4, Indira Agarwal 5, Susan Uthup 6, Abhijeet Saha 7, Om Prakash Mishra 8; Expert Group of Indian Society of Pediatric Nephrology
PMCID: PMC8139225  PMID: 33742610

Abstract

Justification

Steroid sensitive nephrotic syndrome (SSNS) is one of the most common chronic kidney diseases in children. These guidelines update the existing Indian Society of Pediatric Nephrology recommendations on its management.

Objective

To frame revised guidelines on diagnosis, evaluation, management 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 review of literature and evaluation of evidence by experts in two face-to-face meetings.

Recommendations

The initial statements provide advice for evaluation at onset and follow up and indications for kidney biopsy. Subsequent statements provide recommendations for management of the first episode of illness and of disease relapses. Recommendations on the use of immunosuppressive strategies in patients with frequent relapses and steroid dependence are accompanied by suggestions for step-wise approach and plan of monitoring. Guidance is also provided regarding the management of common complications including edema, hypovolemia and serious infections. Advice on immunization and transition of care is given. The revised guideline is intended to improve the management and outcomes of patients with SSNS, and provide directions for future research.

Keywords: Calcineurin inhibitors, Frequent relapses, Levamisole, Minimal change nephrotic syndrome, Mycophenolate mofetil, Rituximab, Steroid dependence

Contributors

All authors were involved in review of literature, preparation of background document, drafting and critically revising the manuscript. All authors approved the final version of the manuscript.

Funding

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].

Footnotes

List of expert group members provided in Annexure I

Note

Supplementary material related to these recommedations is available with the online version at www.indianpediatrics.net

Competing interests

None stated.

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