KDIGO 2025 Clinical Practice Guideline for the Management of Nephrotic Syndrome in Children
KDIGO has released its 2025 focused update for childhood nephrotic syndrome, revising when to biopsy and genetically test and how to choose a glucocorticoid-sparing agent for steroid-sensitive children who relapse frequently or become steroid-dependent.
Background
The prior KDIGO glomerular-disease guidance for children was published in 2021, and KDIGO periodically updates each glomerular disease as new evidence emerges. This focused update revisits Chapter 4 (nephrotic syndrome in children), incorporating randomized-trial evidence published through August 2024 and following an explicit GRADE evidence-review and appraisal process.
Key findings
The update adds a treatment algorithm specifying when to perform kidney biopsy and/or genetic testing, and how to manage steroid-sensitive children who become infrequent relapsers, frequent relapsers, or steroid-dependent. When a glucocorticoid-sparing agent is needed, the choice among a calcineurin inhibitor, oral cyclophosphamide, levamisole, mycophenolate mofetil, and rituximab is individualized to resources, adherence, adverse effects, and patient preferences.
Clinical implications
Clinicians caring for children with steroid-sensitive or steroid-resistant nephrotic syndrome now have refreshed, GRADE-based guidance on diagnosis, prognosis, and treatment sequencing, with explicit acknowledgment of evidence limitations and priority areas for future research.
Category
KDIGO
Source
Kidney International
More from ASNRT News
Browse the latest news, society announcements, KDIGO guideline updates, and AJNT issue releases on the ASNRT newsroom.