KDOQI US Commentary on the KDIGO 2025 Clinical Practice Guideline for the Management of Nephrotic Syndrome in Children

Abstract

The Kidney Disease Outcomes Quality Initiative (KDOQI) convened a work group to review the 2025 KDIGO (Kidney Disease: Improving Global Outcomes) Clinical Practice Guideline for the Management of Nephrotic Syndrome in Children. The KDOQI work group reviewed the KDIGO guideline statements and practice points and provided perspective for implementation within the context of clinical practice in the United States. The updated guidelines reflect contemporary US practice and offer highly relevant guidance that is harmonized with the International Pediatric Nephrology Association’s guidelines published in 2020 and 2022. A focus on close monitoring and characterization of the disease status for children with nephrotic syndrome remains central to treatment and management decisions, noting that the lack of insurance coverage for urine dipsticks in the United States is a significant barrier to optimal disease management. As more treatment options become available to children with nephrotic syndrome, the detailed practice points are a sound tool to help providers engage patients and their families in joint decision making. The clinical utility of the guidelines would be enhanced by inclusion of practice points on the incorporation of genetic testing results into treatment decisions, as well as factors to consider when treating and managing patients at high risk for progression to end-stage kidney disease—those with secondary steroid-resistant nephrotic syndrome and those with the chronic kidney disease high-risk APOL1 genotype. The research needs detailed in the updated guidelines reflect the exciting direction of the practice landscape to provide patient-centered, precision-based care.