What are the criteria for kidney biopsy in children with nephrotic syndrome?

Updated: Mar 04, 2020
  • Author: Jerome C Lane, MD; Chief Editor: Craig B Langman, MD  more...
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Answer

Kidney biopsy should be performed prior to any immunosuppressive treatment, including steroids, in patients who meet one or more of the following criteria:

  • Age younger than 1 year or older than 12 years

  • Presence of recurrent gross hematuria

  • Relevant family history of kidney disease

  • Symptoms of systemic disease

  • Positive viral screens

Additional criteria are laboratory findings possibly indicative of secondary nephrotic syndrome or INS other than minimal change nephrotic syndrome (MCNS), such as the following:

  • Sustained elevation in serum creatinine levels

  • Low complement levels (C3, C4)

  • Positive ANA findings

  • Positive anti–double-stranded DNA antibody assay

In these cases, histology guides treatment, and steroids may or may not be indicated depending on the underlying etiology.

Children older than 12 years require a kidney biopsy because of the rising incidence of focal segmental glomerulosclerosis (FSGS) and other causes of nephrosis in that age range.


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