Role of Corticosteroids in Nephritic Syndrome
I need to clarify an important distinction: you've asked about "nephritic syndrome," but the evidence provided exclusively addresses "nephrotic syndrome"—these are fundamentally different clinical entities. Nephritic syndrome (characterized by hematuria, hypertension, and acute kidney injury) has different underlying pathologies and treatment approaches than nephrotic syndrome (characterized by heavy proteinuria, hypoalbuminemia, and edema).
If You Meant Nephrotic Syndrome:
Corticosteroids are the cornerstone first-line therapy for nephrotic syndrome, with specific dosing and duration depending on the underlying histology and patient age. 1
For Adults with Minimal Change Disease (MCD):
Initial treatment: Prednisone 1 mg/kg/day (maximum 80 mg) or 2 mg/kg on alternate days (maximum 120 mg) for a minimum of 4 weeks, up to a maximum of 16 weeks if complete remission is not achieved. 1
After achieving remission, taper slowly over 6 months. 1
Response rates are high (76% within 8 weeks), though adults respond more slowly than children. 2
Relapse occurs in approximately 34% of adults, with younger patients (<30 years) having higher relapse rates. 2
For Adults with Focal Segmental Glomerulosclerosis (FSGS):
Use the same dosing regimen as MCD: 1 mg/kg/day (maximum 80 mg) for 4-16 weeks, followed by a 6-month taper. 1
Corticosteroids should only be used in idiopathic FSGS with nephrotic syndrome—not in secondary FSGS. 1
Over 50% of adults are steroid-resistant, and alternative agents (calcineurin inhibitors) should be considered early. 1
For Children with Nephrotic Syndrome:
First episode: 60 mg/m²/day or 2 mg/kg/day (maximum 60 mg) for 4-6 weeks, followed by 40 mg/m²/day or 1.5 mg/kg on alternate days (maximum 40 mg) for 2-5 months with tapering. 1, 3
Total treatment duration should be at least 12 weeks, with longer courses (up to 6 months) reducing relapse risk. 1
For relapses: Same initial dose until remission for 3 days, then alternate-day dosing for at least 4 weeks. 1
For frequently relapsing or steroid-dependent disease, glucocorticoid-sparing agents (cyclophosphamide, calcineurin inhibitors, rituximab, levamisole, or mycophenolate mofetil) should be introduced to prevent steroid toxicity. 1
Critical Caveats:
Corticosteroids have NO role in maintenance therapy for either ulcerative colitis or Crohn's disease (this was mentioned in one guideline but is irrelevant to nephrotic syndrome). 1
For patients with contraindications to high-dose steroids (uncontrolled diabetes, psychiatric conditions, severe osteoporosis), consider calcineurin inhibitors or cyclophosphamide as first-line therapy instead. 1
Steroid resistance is defined as failure to respond after 8 weeks of treatment in children. 1
In membranous nephropathy, steroids alone are generally not recommended; combination therapy with alkylating agents or rituximab is preferred. 1
If You Actually Meant Nephritic Syndrome:
For true nephritic syndrome (such as post-infectious glomerulonephritis or IgA nephropathy with acute nephritic features), corticosteroid use is controversial and depends on the specific underlying cause. The evidence provided does not adequately address this scenario, as it focuses on nephrotic rather than nephritic presentations. For IgA nephropathy with proteinuria >1 g/day despite maximal supportive care, oral glucocorticoids may be considered, but this represents a nephrotic rather than nephritic presentation. 1