To biopsy or not to biopsy a teenager with typical idiopathic nephrotic syndrome? Start steroids first.

Pediatr Nephrol

Néphrologie Pédiatrique, Centre de Référence du Syndrome Néphrotique Idiopathique de L'enfant Et L'adulte, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris (APHP), Institut Imagine, INSERM U1163, Université Paris Cité, 149 Rue de Sèvres, 75015, Paris, France.

Published: September 2024

AI Article Synopsis

  • - Minimal change disease (MCD) and focal segmental glomerulosclerosis are common in children with idiopathic nephrotic syndrome, with MCD being highly responsive to steroids and generally not requiring a kidney biopsy at diagnosis.
  • - Kidney biopsies should be reserved for atypical symptoms, steroid resistance, or to investigate possible systemic diseases, as they are invasive and can cause complications.
  • - New non-invasive biomarkers are being developed to reduce the need for biopsies, and starting steroid treatment in teenagers with typical nephrotic syndrome is a sensible approach.

Article Abstract

It is well known that minimal change disease (MCD) and focal segmental glomerulosclerosis are the most common histopathology findings in children with idiopathic nephrotic syndrome. Moreover, several studies demonstrated that MCD is associated with high steroid-responsiveness and a low incidence of kidney failure, suggesting that routine kidney biopsy is not warranted. Over time, the indications for performing a kidney biopsy have become increasingly stringent, aiming to limit unnecessary invasive procedures in the paediatric population. The most recent guidelines state that a kidney biopsy is not usually necessary at disease onset. Still, it should be performed in case of atypical features suggestive of systemic diseases or glomerulonephritis and in case of steroid-resistance, to assess the different differential diagnoses, regardless of patient age. Moreover, it has been shown that the best prognostic marker in childhood nephrotic syndrome is response to treatment and that kidney histology is not accurate in predicting prognosis. Furthermore, a kidney biopsy is not necessary to predict the relapsing course. Notably, kidney biopsy is an invasive procedure and may lead to significant complications. Finally, novel non-invasive biomarkers have been validated or are in the process of being approved to guide differential diagnoses and thus limit the need for kidney biopsies in patients with typical nephrotic syndrome. In the following sections, we aim to explain why initiating steroid treatment as the initial approach in teenagers with typical nephrotic syndrome is a reasonable strategy. Additionally, we explore how kidney biopsy indications may be alleviated in this population.

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Source
http://dx.doi.org/10.1007/s00467-024-06447-wDOI Listing

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