Interpretation of the KDIGO 2025 clinical practice guideline for the management of nephrotic syndrome in children
WANG Jing-jing
MAO Jian-hua
Abstract：Primary nephrotic syndrome is the most common glomerular disease in childhood.The 2025 KDIGO Guidelines integrate the latest evidence to update the diagnosis and treatment strategies for childhood steroid-sensitive nephrotic syndrome(SSNS)and steroid-resistant nephrotic syndrome(SRNS).In diagnosis,some definitions are revised,and a"confirmation period"is proposed to clarify the diagnosis of SRNS;prognosis is related to the response to glucocorticoids and the frequency of relapses.In treatment,an 8-12-week regimen of initial glucocorticoids is recommended,with individualized use of glucocorticoids during infections.For frequently relapsing/steroid-dependent nephrotic syndrome(FR/SDNS),combination therapy with steroid-sparing agents[such as calcineurin inhibitors(CNIs),rituximab,etc.]is suggested.For SRNS,genetic testing should be performed as soon as possible,with CNIs as the initial second-line treatment.The outlook indicates that future research should focus on the exploration of shortening the initial course of glucocorticoids,optimizing the selection and dosage of steroid-sparing agents,achieving stratified diagnosis and treatment by integrating genetics and biomarkers,while paying attention to the safety of B-cell depletion therapies and quality-of-life endpoints to promote precision medicine practice.
Keywords：childguidelinenephrotic syndromesteroid-sparing agents
Publication Date：2025-07-06
Online Publishing Date：2025-09-04(First online date of this platform, not the publication date of the document)
Pages：6( 529-534 )