Reply to the letter from P. Geier et al.

Sirs,

We appreciate the opportunity to respond to the thoughtful comments of Dr. Geier and his colleagues [1] about our article “Evidence-based management of steroid-sensitive nephrotic syndrome” in Pediatric Nephrology [2].

We do not agree that the results of our systematic review [3] fail to inform clinicians about the management of a child with his/her initial episode of SSNS. The primary purpose of a systematic review is to present an unbiased synthesis of the best available research information relevant to the clinical question, rather than to provide rigid recommendations for treatment. The latter require additional considerations including availability of interventions and estimation of baseline risks. The conclusions drawn are designed to help people to understand the implications of the evidence when making practical decisions based on local conditions. However, we would suggest that the trial data available to inform clinicians about steroid use for this indication are relatively numerous, especially in comparison with many other clinical problems in paediatric nephrology. Dr. Geier and colleagues imply that because the evidence base is not perfect, “experts” should decide, and that the experts should weight the findings of the Arbeitsgemeinschaft für Pädiatrische Nephrologie (APN) trial [4] over the ten other trials, which are relevant, and ignore the data showing that courses longer than 3 months reduce the likelihood of relapses. We disagree.