19/08/2026
Child with steroid sensitive nephrotic syndrome , presented with relapse , how to treat relapse?
For a child with steroid-sensitive nephrotic syndrome (SSNS) presenting with a relapse, the standard treatment is oral prednisolone/prednisone.
1. Confirm relapse
Relapse is usually defined as 3+ or 4+ proteinuria on urine dipstick for 3 consecutive days after having achieved remission.
Assess:
* BP, weight, edema, hydration
* Urine protein/creatinine ratio if needed
* Serum albumin, urea/creatinine, electrolytes if clinically indicated
* Look for infection, especially fever, abdominal pain, cellulitis, respiratory infection
* Ask about steroid adherence.
2. Prednisolone treatment — uncomplicated relapse
Prednisolone 2 mg/kg/day OR 60 mg/m²/day PO once daily in the morning
Maximum 60 mg/day.
Continue the daily dose until complete remission for ≥3 consecutive days.
Then:
Prednisolone 1.5 mg/kg OR 40 mg/m² PO on alternate days
Maximum 40 mg/dose, for 4 weeks.
No further taper is generally required after this 4-week alternate-day course.
Example
For a 20-kg child:
* Relapse: 40 mg prednisolone once daily
* Once urine protein is negative/trace for ≥3 days:
* 30 mg alternate days × 4 weeks
For a 30-kg child:
* Relapse: 60 mg once daily (maximum)
* After remission: 40 mg alternate days × 4 weeks.
3. When it is NOT simply an ordinary relapse
If the child has:
* Frequent relapses — ≥2 relapses within 6 months or ≥4 within 12 months
* Steroid dependence — relapse while receiving steroids or within ~14 days of stopping
* Significant steroid toxicity
* Relapse despite appropriate steroid therapy
* Features suggesting steroid-resistant disease
→ involve pediatric nephrology and consider a steroid-sparing agent such as levamisole, mycophenolate mofetil, tacrolimus/cyclosporine, cyclophosphamide or rituximab depending on the clinical situation.
4. Important supportive management
Do not routinely give albumin + furosemide just because the child has edema.
Use:
* Salt restriction if significant edema
* Normal age-appropriate fluid intake unless severe edema/hyponatremia
* Daily weight and urine protein monitoring
* Treat infections promptly
* Vaccination review
* Assess for thrombosis if severe edema/hypoalbuminemia or suggestive symptoms.
Urgent admission if severe edema/ascites with respiratory compromise, hypovolemia/shock, serious infection/sepsis, thrombosis, severe hypertension, AKI, or significant electrolyte disturbance.
Key regimen to remember:
Relapse → Prednisolone 2 mg/kg/day (max 60 mg) → remission ≥3 days → 1.5 mg/kg alternate days (max 40 mg) × 4 weeks.
If you give me the child’s weight, age, current urine protein, albumin, creatinine, degree of edema, and previous steroid regimen, I can calculate the exact dose and outline the ER/inpatient management including edema, albumin, diuretics, infection and thrombosis precautions.
