Secondary steroid resistance of idiopathic nephrotic syndrome in children: state of the problem

Abstract

The concept of the steroid resistance in children with nephrotic syndrome, who were initially sensitive to steroids, has been known for a long time. Despite several foreign studies, this problem remains largely unexplored. The results of the presented review demonstrate a lack of information on many important aspects of resistant nephrotic syndrome. In particular, the true causes and pathogenesis of glucocorticosteroid resistance remain unknown, despite the long history of this problem in pediatric nephrology. On the one hand, such patients are clinically similar to the patients with steroid-resistant nephrotic syndrome, but at the same time they have a relatively favorable outcome in general. On the other hand, the ambiguous response to the steroid and immunosuppressive therapy hinders the development of a unified concept of the disease and pathogenetic therapy. Thus, an important task for future research is to find the reasons for the development of late (secondary) steroid resistance and, to develop and implement a personalized therapeutic approach to the management of children into clinical practice.