Seventy years ago, steroids transformed the outcomes for children with nephrotic syndrome, reducing the mortality rate from 67 to 3%. In the 1960s and 70s, the collaborative research group, the International Study for Kidney Disease in Children (ISKDC) derived steroid regimens from consensus that have been modified slightly but largely stood the test of time. In 2022, we continue to use steroids as mainstay in treatment of the initial episode and relapses.  We recognise the common adverse effects these drugs have yet struggle to generate the evidence to use them in ways that maximise efficacy but minimise toxicity. This talk will review the ways in which we use steroids in steroid sensitive nephrotic syndrome, highlight the gaps in our knowledge and suggest how future clinical trials might address these gaps. It will cover the steroid treatment for the first episode, dosing by weight or body surface area, treatment of relapses, prevention of relapses and whether steroid treatment can be individualised.