How long do you observe for spontaneous remission after NSAID discontinuation before initiating corticosteroids in a patient with biopsy-confirmed minimal change disease?

Generally, once you stop NSAIDs, proteinuria should improve in 2-4 weeks, but if proteinuria persists beyond this period, I would initiate steroids. If they have heavy proteinuria from the get-go with nephrotic syndrome complications like VTE, I initiate steroids right away.

The role of steroid treatment in drug-induced acute interstitial nephritis (DI-AIN), including those with MCD, is controversial. There are no large randomized controlled trials, so whether steroids are beneficial or not, and when to give them, is unclear. There have been a number of retrospective st...