Executive summary of the KDIGO 2025 Clinical Practice Guideline for the Management of Nephrotic Syndrome in Children.

Abstract

The Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for the Management of Glomerular Diseases was last updated and published in 2021. KDIGO continues to be committed to the nephrology community to provide periodic updates, based on new developments for each of the glomerular diseases. For children with nephrotic syndrome, the updated guideline now contains a treatment algorithm on when to perform a kidney biopsy and/or genetic testing and which immunosuppressive therapy to use in children with a complete response to glucocorticoids (steroid sensitive), who subsequently become infrequent or frequent relapsers or even steroid dependent. If a glucocorticoid-sparing agent must be considered after failure of an initial glucocorticoid therapy to induce remission, the choice among a calcineurin inhibitor, oral cyclophosphamide, levamisole, mycophenolate mofetil, and rituximab is a decision that requires consideration of patient-related issues such as resources, adherence, adverse effects, and patient preferences. Herein, an executive summary of the most important changes in the KDIGO 2025 Clinical Practice Guideline for the Management of Nephrotic Syndrome in Children is provided as a quick reference.