(New York, NY – January 21, 2026) – The National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (NKF KDOQI) has released a Commentary on the Kidney Disease: Improving Global Outcomes (KDIGO) 2025 Clinical Practice Guideline for the Management of Nephrotic Syndrome in Children. KDOQI Commentaries help U.S. audiences better understand the applicability of relevant international guidelines in their local clinical environment. Both the guideline and the commentary recommendations provide updated, evidence-based guidance for physicians and families.
In children, nephrotic syndrome is one of the most common kidney diseases and a leading cause of kidney failure. The guideline highlights important advances in treatment and monitoring, while underscoring the role of family engagement and shared decision-making in the child’s care.
The guideline reinforces that a child’s response to initial steroid therapy remains the strongest predictor of long-term kidney health. An 8-to-12-week course of corticosteroid treatment is recommended for the first episode of nephrotic syndrome, as this approach can provide effective disease control while reducing the risks of long-term steroid exposure. For children who do not respond to steroids, the guideline recommends calcineurin inhibitors such as cyclosporine or tacrolimus as second-line therapies. Factors to consider in the use of other steroid-sparing medications for relapse prevention, including rituximab and mycophenolate mofetil, are also described.
The KDOQI Commentary highlights the importance of home monitoring to detect early relapses and guide timely treatment adjustments. A significant barrier identified for families in the U.S. is the insufficient insurance coverage for urine dipsticks, a simple but essential tool used by parents. Lead authors are Dr. Chia-shi Wang of Emory University and Children’s Healthcare of Atlanta and Dr. Rasheed Gbadegesin of Duke University School of Medicine.
“We now have more treatment options than ever for children with nephrotic syndrome, but ensuring equal access is critical,” said Wang. “By combining new science with practical guidance, these recommendations help providers and families make informed decisions.”
“These guidelines give families clearer choices and bring new hope,” added Gbadegesin. “The goal is better outcomes, fewer side effects, and improved quality of life for children.”
The recommendations also call for additional research to refine steroid regimens, evaluate the efficacy and long-term safety of new B cell directed therapies, and improve the utility of genetic evaluations in clinical care. These priorities are essential for advancing personalized treatment and improving outcomes for children with this challenging condition.
The NKF’s KDOQI develops evidence-based clinical practice guidelines and commentaries to improve kidney health and patient outcomes across the United States. To learn more, go to: https://www.ajkd.org/content/kdoqiguidelines
About Kidney Disease
In the United States, CKD remains an under-recognized public health burden that impacts 1 in 7 adults, and 90 percent of those affected are unaware of their condition. Approximately 1 in 3 U.S. adults are at risk for CKD, but less than 20% are assessed with guideline-recommended testing, eGFR and uACR. Risk factors for kidney disease include diabetes, high blood pressure, heart disease, obesity, and family history. People of Black or African American, Hispanic or Latino, American Indian or Alaska Native, Asian American, or Native Hawaiian or Other Pacific Islander descent are at increased risk for developing the disease. Black or African American people are about four times as likely as White people to develop kidney failure. Hispanic and Native American people experience kidney failure at approximately double the rate of White people.
About the National Kidney Foundation
The National Kidney Foundation is revolutionizing the fight to save lives by eliminating preventable kidney disease, accelerating innovation for the dignity of the patient experience, and dismantling structural inequities in kidney care, dialysis, and transplantation. For more information about NKF, visit www.kidney.org.
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Contact:
Sam Tyler 212.889.2210 x 141
Email: sam.tyler@kidney.org