April 18, 2025
[Brussels, Belgium] Kidney Disease: Improving Global Outcomes (KDIGO) is pleased to announce the publication of the KDIGO 2025 Clinical Practice Guideline for the Management of Nephrotic Syndrome in Children. This new guideline represents an update to Chapter 4 of the KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases (GD) 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.”
The 2025 Nephrotic Syndrome in Children Guideline and Executive Summary are available now on the KDIGO and Kidney International websites. The next chapter update in KDIGO’s Glomerular Diseases series will focus on IgA Nephropathy and IgA Vasculitis (IgAN/V), with publication anticipated in the fall of 2025.
