The KDIGO 2025 Clinical Practice Guideline for the Management of Nephrotic Syndrome in Children was published online in April 2025 and will be available in the May issue of the Supplement of Kidney International, with an Executive Summary in the main pages of the journal. This new guideline represents an update to Chapter 4 of The 2021 Clinical Practice Guideline for the Management of Glomerular Diseases and is part of KDIGO’s ongoing effort to update the 2021 GD Guideline chapter by chapter as new evidence becomes available.
The updated guideline addresses recent advances in the treatment of nephrotic syndrome in children, including both steroid-sensitive and steroid-resistant forms of the disease. Developed through a rigorous and transparent process involving systematic evidence review, public comment, and consensus by a global expert Work Group, the guideline provides clear and actionable recommendations for healthcare providers. As with all KDIGO guidelines, the development process followed the KDIGO Methods Manual and incorporated the GRADE approach to assess the strength of recommendations and certainty of evidence.
“This update brings much-needed clarity to the optimal use of glucocorticoids and glucocorticoid-sparing agents in children with nephrotic syndrome,” said Brad Rovin, MD (United States), Guideline Co-Chair. “Key guideline recommendations are mostly unchanged, but important refinements have been made. There is now stronger evidence for shorter initial glucocorticoid courses and a better grasp of the impact of upper respiratory infections. The distinction between first-line and alternative agents is gone; selection of steroid-sparing therapies (like cyclophosphamide, mycophenolate mofetil, and rituximab) should now be based purely on the patient’s clinical situation. These refinements make a real difference in reducing treatment burden and protecting growing bodies during critical years of development.”
“This is more than just an update—it’s a vital recalibration of how we treat pediatric nephrotic syndrome worldwide,” said Jürgen Floege, MD (Germany), Guideline Co-Chair. “The guideline now aligns with the International Pediatric Nephrology Association guideline in defining clinical scenarios presented in this glomerular disease. It also addresses critical clinical decisions such as when to perform a biopsy, when to initiate genetic testing, and how to manage multidrug-resistant cases. We aim to empower clinicians to deliver the most precise, least harmful care possible to this vulnerable population.”
Download the KDIGO 2025 Nephrotic Syndrome in Children Guideline from the guideline suite (right) or read the guideline on the Kidney International website.
DISCLAIMER: USE OF THE CLINICAL PRACTICE GUIDELINES
This Clinical Practice Guideline is based upon the best information available at the time of publication. The recommendations are designed to provide information and assist decision-making. They are not intended to define a standard of care, and should not be construed as one. Neither should they be interpreted as prescribing an exclusive course of management. Variations in practice will inevitably and appropriately occur when clinicians take into account the needs of individual patients, available resources, and limitations unique to an institution or type of practice. Every health care professional making use of this Guideline is responsible for evaluating the appropriateness of applying them in the setting of any particular clinical situation. The recommendations for research contained within this document are general and do not imply a specific protocol.
