What is the role of biopsy in the workup of pediatric nephrotic syndrome?

Updated: Mar 04, 2020
  • Author: Jerome C Lane, MD; Chief Editor: Craig B Langman, MD  more...
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A kidney biopsy is not indicated for the first presentation of INS in children aged 1-12 years unless the history, physical findings, or laboratory results indicate the possibility of secondary nephrotic syndrome or primary nephrotic syndrome other than MCNS. Kidney biopsy is indicated in patients younger than 1 year, when genetic forms of congenital nephrotic syndrome are more common, and in patients older than 12 years, when chronic glomerular diseases such as FSGS have a higher incidence. [59]

A kidney biopsy is also indicated if the patient has any of the following:

  • Symptoms of systemic disease (eg, fever, rash, joint pain)

  • Laboratory findings indicative of secondary nephrotic syndrome (eg, positive ANA result, positive anti–double-stranded DNA antibody findings, low complement levels)

  • Elevated creatinine levels unresponsive to correction of intravascular volume depletion

  • A relevant family history of kidney disease

Finally, in patients who are initially or subsequently unresponsive to steroid treatment, kidney biopsy should be performed, because steroid unresponsiveness has a high correlation with prognostically unfavorable histology findings, such as those associated with FSGS or membranous glomerulonephritis (MGN).

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