This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Pediatrics
A child comes with steroid resistant nephrotic syndrome secondary to FSGS, not responsive .to methylprednisolone. What next should be given ? 
Select and explain. 
A. Oral cyclophosphamide, B. Oral cyclosporine, C. Oral mycophenolate, D. IV cyclophosphamide
B: Oral cyclosporine
Answer: B: Oral cyclosporine 
Explanation: Ans is 'b' i.e., Oral cyclosporine o The treatment options for steroid resistant nephrotic syndrome are: (i) Calcineurin inhibitors (cyclosporine, Tacrolimus) (ii) IV or oral cyclophosphamide (iii) Levamisol (iv) Mycophenolate (v) Pulse coicosteroid o All above immunosuppressants are used along with coicosteriods (Prednisolone or methylprednisolone). o Cyclosporine and cyclophosphamide are most commonly used. o Despite these options, there is lack of consensus on first line appropriate therapy for steroid resistant nephrotic syndrome. o According to Indian Journal of pediatric (vol. 46, Jan 17, 2009) the efficacy of these durgs are (in decreasing order): Tacrolimus + Prednisolone > cyclosporine + Prednisolone > IV cyclophosphamide + Prednisolone > Pulse Corticosteroids (IV dexamethasone + oral cyclophosphamide + Prednisolne) > oral cyclophosphamide + PrednisoIon e. o So, amongst the given options, best answer is cyclosporine.