The prevalence of childhood nephrotic syndrome is 1:6,000.¹ Treatment and prognosis of primary nephrotic syndrome depend on cause, therefore early etiologic identification is a crucial step in management. Children with minimal change nephrotic syndrome (MCNS) can typically be managed with prednisone with an excellent prognosis, whereas children with other etiologies of nephrotic syndrome may require alternative therapies, progress to renal failure, or have other adverse outcomes. Common practice had been an initial corticosteroid trial with renal biopsy reserved only in those for whom this course failed. However, there was no supportive evidence and it was unclear if non-MCNS cases were being missed.

To determine the predictive value of initial corticosteroid response in differentiating MCNS from other etiologies of primary nephrotic syndrome in children.

Prospective cohort study at centers in the US, Canada, and Europe from 1967 to 1976.