Aligning Practice With Guidelines: A Canadian National Survey and Canadian Society of Nephrology Commentary on the 2025 KDIGO Pediatric Nephrotic Syndrome Recommendations

The purpose of this commentary is to review the 2025 Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guidelines on the management of childhood nephrotic syndrome (NS) within the Canadian context and based on current practices across the country.

The KDIGO 2025 guideline on the management of childhood nephrotic syndrome as well as the KDIGO 2021 management of glomerular diseases, chapter 4 (NS in children) were main sources. The International Pediatric Nephrology Association clinical practice recommendations for the diagnosis and management of children with steroid sensitive NS and the recommendations for the diagnosis and management of children with steroid resistant NS were also used.

The Canadian Society of Nephrology convened a working group of pediatric nephrologists with representation from across Canada. As part of the review, the working group conducted a survey of pediatric nephrology centres in Canada to better understand current practice in NS management. All members reviewed the recommendations and practice points, reaching consensus through discussion. Results from the survey as well as published literature from Canadian NS cohorts were used to develop commentary on the application of KDIGO recommendations in the Canadian context.

The authors agreed with most updated KDIGO recommendations and emphasized the benefits of standardizing disease and response type definitions, as well as prednisone induction protocols. However, areas in need of further clarity and standardization were highlighted including relapse treatment protocols, and choice of steroid sparing agents for frequently relapsing and steroid dependent patients.

A review of the quality of evidence was not undertaken.