Evolving Consensus on Management of Nephrotic Syndrome in Childhood: Focus on KDIGO Guidelines 2025

Nephrotic syndrome, characterized by heavy proteinuria, edema, and hypoalbuminemia, is among the most common chronic kidney diseases of childhood, with an annual incidence of 2.9 (0-6.5) per 100,000 children. 1 In >80% of children, the proteinuria completely remits within 4-6 weeks of corticosteroid therapy, termed steroid-sensitive nephrotic syndrome (SSNS). 2,3Patients with SSNS may show infrequent or frequent relapses but have satisfactory long-term outcomes. 3Lack of complete remission following therapy, termed steroid resistance (SRNS), may be observed at the onset of disease (initial steroid-resistance) or following a relapse (late-resistance), and carries a high risk of disease and therapy-associated complications, including kidney failure. 2Over the past 3 decades, evidence-based guidelines have refined the therapy of nephrotic syndrome.Guidelines on management of nephrotic syndrome were published by the Indian