Steroid-Dependent Nephrotic Syndrome With Remission After Rituximab Implementation in a 14-Year-Old Boy: A Case...

Steroid-dependent nephrotic syndrome (SDNS) in children poses significant therapeutic challenges due to frequent relapses and the risks linked to prolonged immunosuppressive treatment. We present a case of a 14-year-old boy diagnosed with steroid-sensitive nephrotic syndrome onset at three years old who progressed to steroid dependence with multiple relapses despite the therapy with calcineurin inhibitors and mycophenolate mofetil. The patient developed complications including growth retardation, Cushingoid features, and persistent hypertension. Renal biopsy confirmed focal segmental glomerulosclerosis (FSGS), which is a histological variant associated with poor treatment response. After limited success with conventional therapies administered from November 2013 to December 2024, rituximab was initiated, resulting in sustained remission and enabling complete withdrawal of immunosuppressive agents. Post-rituximab, the patient also received growth hormone therapy, which contributed to improved growth and overall clinical condition. This case highlights the complexity of managing SDNS with FSGS and supports rituximab's role in refractory cases, while underscoring the importance of monitoring for adverse effects.