<prompt> A child comes with steroid resistant nephrotic syndrome secondary to FSGS, not responsive .to methylprednisolone. What next should be given ?Oral cyclophosphamideOral cyclosporineOral mycophenolateIV cyclophosphamide  <response>: 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. 