Ask the expert: In steroid sensitive nephrotic syndrome (SSNS) in children, is there clear evidence that steroids given every second day are more beneficial in terms of reducing relapse rate and side effects compared with half the dose given every day?

The questioner asks whether, in steroid sensitive nephrotic syndrome (SSNS) in children, there is clear evidence that steroids given every 2nd day are more beneficial in terms of reducing re-lapse rate and side effects compared with half the dose given every day. A related question is whether further trials are required.Historically no randomised placebo-controlled trials were under-taken to confirm the efficacy of steroids in nephrotic syndrome.Several ad hoc steroid regimens using high dose daily prednisone (60 mg/m2/day) were developed to induce and maintain remission[1, 2]. Following reports of similar efficacy, fewer adverse effects and less adrenal suppression compared with daily steroids [3–5],prolonged courses of intermittent (given on three consecutive days out of 7 days) or alternate day steroids were used by some to maintain remission. There were also case reports [2, 5] of successful induction of remission with prednisone given on alternate days at double the daily dose (90–120 mg/m2/dose).