Systemic paediatrics: steroid resistant nephrotic syndrome: practice question

A Pediatrics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pediatrics · Systemic paediatrics: steroid resistant nephrotic syndrome

Sample item

A 6-year-old with nephrotic syndrome has persistent proteinuria after 6 weeks of daily prednisolone. What is the best next step?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Renal biopsy, as steroid resistance often signifies FSGS, with a calcineurin inhibitor to follow

Steroid-resistant nephrotic syndrome is persistent proteinuria despite 4 to 6 weeks of daily steroids. Biopsy often shows focal segmental glomerulosclerosis, and calcineurin inhibitors such as tacrolimus or cyclosporine are first-line.

Option by option

  • A. Switch to diuretics alone

    Diuretics treat oedema, not the disease.

  • B. Renal biopsy, as steroid resistance often signifies FSGS, with a calcineurin inhibitor to follow (correct)

    Correct. Biopsy and calcineurin inhibitor are recommended.

  • C. Continue prednisolone for 6 more months

    Prolonged steroids add toxicity without benefit.

  • D. Start cyclophosphamide without biopsy

    Cyclophosphamide is less effective in SRNS.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pediatrics question

What is the answer to this Pediatrics question?

The best answer is B, Renal biopsy, as steroid resistance often signifies FSGS, with a calcineurin inhibitor to follow. Steroid-resistant nephrotic syndrome is persistent proteinuria despite 4 to 6 weeks of daily steroids.

Why is "Switch to diuretics alone" not the answer?

Diuretics treat oedema, not the disease.

Why is "Continue prednisolone for 6 more months" not the answer?

Prolonged steroids add toxicity without benefit.

Why is "Start cyclophosphamide without biopsy" not the answer?

Cyclophosphamide is less effective in SRNS.

What concept does this question test?

It tests Systemic paediatrics: steroid resistant nephrotic syndrome in Pediatrics. Biopsy often shows focal segmental glomerulosclerosis, and calcineurin inhibitors such as tacrolimus or cyclosporine are first-line.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Systemic paediatrics: steroid resistant nephrotic syndrome?

Memorise milestones and the vaccine schedule as tables and revise them often. Then use the flashcards and the other Pediatrics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.