4.5 Article

Is kidney biopsy necessary in children with idiopathic nephrotic syndrome?

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ACTA PAEDIATRICA
卷 -, 期 -, 页码 -

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WILEY
DOI: 10.1111/apa.16959

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kidney biopsy; paediatric nephrotic syndrome

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This study investigated the need for kidney biopsy in children with steroid-sensitive nephrotic syndrome in the Northern European setting. The results showed that kidney biopsy is rarely necessary in steroid-sensitive children without any other complicating factor, and therefore, the liberal policy of kidney biopsy in the Nordic countries can be safely changed.
Aim: To investigate the need, in the Northern European setting, to perform kidney biopsy in children with steroid-sensitive nephrotic syndrome.Methods: In this retrospective study 124 individuals aged 1-18 years with idiopathic nephrotic syndrome, followed in the paediatric hospitals in southern Sweden from 1999 to 2018, were included.Results: There was a median follow-up time of 6.5 (0.2-16.8) years. The majority (92%) of children were steroid-sensitive and of them, 60.5% were frequently relapsing or steroid-dependent. Microscopic haematuria was found at onset in 81.1% and hypertension in 8.7%. At least one kidney biopsy was performed in 93 (75%). The most common indication was a steroid-dependent or relapsing course (58.4%). One of 79 steroid-sensitive children had another histological diagnosis than minimal change nephropathy 1.3%, 95% confidence interval (0.002, 0.068). Bleeding occurred after eight biopsies (6.6%). Twenty individuals (30.7%) were transferred to adult units, 18 still on immunosuppression.Conclusion: We have in our cohort of unselected children with idiopathic nephrotic syndrome confirmed that a kidney biopsy rarely gives important medical information in steroid-sensitive children without any other complicating factor and that the liberal policy of kidney biopsy in the Nordic countries safely can be changed.

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