steroid‑resistant nephrotic syndrome (SRNS)

Future research recommendations for the management of steroid‑resistant nephrotic syndrome in children in the Egyptian context could include: • National Genetic Profile Registries: Conducting nationwide epidemiological and genetic mapping studies to identify common monogenic mutations unique to Egyptian pediatric SRNS cases, particularly in regions with high rates of consanguinity. • Efficacy and Safety of Novel Biologics: Carrying out multicenter prospective clinical trials to assess the long-term safety, optimal dosing, and efficacy of steroid-sparing agents (e.g., Rituximab, Mycophenolate Mofetil) and complement inhibitors within the local healthcare setting. • Post-Transplant Recurrence Outcomes: Establishing long-term registry tracking to better quantify recurrence rates of non-genetic SRNS post-kidney transplantation in living-related donor cohorts. • Secondary Cause Screen Optimization: Developing standardized, cost-effective screening protocols for endemic infections (such as schistosomiasis or hepatitis) that contribute to secondary nephrotic syndrome. These recommendations aim to address specific challenges and characteristics of the Egyptian context, potentially leading to more effective prevention and management strategies for steroid‑resistant nephrotic syndrome in children. Challenges • High Cost & Limited Access to Genetic Testing: Genetic testing remains expensive, limited to a few tertiary centers, and is not fully covered by national medical insurance, necessitating reliance on renal biopsy and laboratory immunology. • High Rates of Consanguinity: Consanguinity presents unique diagnostic challenges for living-related organ donation, requiring extensive genetic counseling and pre-transplant donor screening. Strengthen the evidence base of the next update of this guideline by generating GRADE summary of finding tables, evidence profiles, and EtD frameworks.