Table 2.

General Principles for Children With Nephrotic Syndrome

Indication for kidney biopsy	• Children presenting with nephrotic syndrome ≥ 12 years of age • Steroid-resistant nephrotic syndrome or subsequent failure to respond to glucocorticoids in steroid-sensitive nephrotic syndrome (secondary steroid-sensitive nephrotic syndrome) • A high index of suspicion for a different underlying pathology (macroscopic hematuria, systemic symptoms of vasculitis, hypocomplementemia, etc.) • At onset, kidney failure not related to hypovolemia. Subsequently, decreasing kidney function in children receiving calcineurin inhibitors or prolonged exposure to calcineurin inhibitors (2 to 3 years)
Genetic testing	• Steroid-resistant nephrotic syndrome • Congenital and infantile forms of nephrotic syndrome (<1 year of age) • Nephrotic syndrome associated with syndromic features • Family history of steroid-resistant nephrotic syndrome or focal segmental glomerulosclerosis
Vitamin D/calcium	In patients with steroid-sensitive nephrotic syndrome and normal vitamin D levels, supplementation is not required. However, in frequently relapsing nephrotic syndrome or steroid-dependent nephrotic syndrome in children or in the presence of a known vitamin D deficiency, a reduction in bone mineral content can be prevented by oral supplementation with oral calcium and vitamin D.42,43
Gastroprotection	There is insufficient evidence of benefit to recommend prophylactic use of proton-pump inhibitors in children with nephrotic syndrome in the absence of risk factors for gastrotoxicity or of gastric symptoms