New lessons from randomized trials in steroid-sensitive nephrotic syndrome: clear evidence against long steroid therapy.

The best initial therapy for steroid-sensitive nephrotic syndrome (SSNS) in children is subject to ongoing debate. Systematic reviews and meta-analyses have concluded that at least 3 months and up to 7 months of treatment would reduce the number of relapses by 30%. But summarizing small underpowered studies cannot eliminate the basic flaws in design. Two well-powered randomized prospective trials now come to the opposite conclusion, and these results should impact the management of children with SSNS.