Pediatric Nephrology https://doi.org/10.1007/s00467-026-07277-8 LE T TER TO THE EDITORS Reply to: “Comment on: Single relapse at ≥ 0.5 mg/kg alternate‑day prednisone predicts course of childhood nephrotic syndrome” 1 2,3 Abigail A. Lazar · Amit Dagan Received: 11 March 2026 / Revised: 11 March 2026 / Accepted: 13 March 2026 © The Author(s), under exclusive licence to International Pediatric Nephrology Association 2026 To the Editors, patients after a single relapse—rather than after multiple steroid courses—could fundamentally change how we man- We thank Drs. Ria, Castaldo, and Nardini [1] for their insight- age childhood nephrotic syndrome, sparing countless chil- ful comments and for independently corroborating our find- dren the cumulative toxicity of glucocorticoid exposure. ings [2]. Their observation that 97% of children who relapsed on prednisone ≥ 0.5 mg/kg every other day (EOD) developed Funding No external funding was received for this work. frequently relapsing or steroid-dependent nephrotic syndrome (FR/SDNS) is consistent with our data (98.7%). Data Availability The data supporting the findings of this study are The concern raised by Ria et al. regarding premature available from the corresponding author upon reasonable request. initiation of steroid-sparing agents (SSAs) motivated our Declarations analysis of Figs. 3 and 4 (in ref [2]). Figure 3 shows that while relapse on any prednisone dose carries high FR/SDNS Conflict of interest The authors declare that they have no conflicts of risk, this risk increases progressively with higher doses, interest relevant to this manuscript. approaching 100% at ≥ 0.5 mg/kg EOD. This suggests that steroid dose at...