Is renal biopsy necessary in adults with nephrotic syndrome.

Adults presenting with nephrotic syndrome conventionally undergo renal biopsy before therapy is administered, whereas children with nephrotic syndrome receive a therapeutic trial of corticosteroids without prior renal biopsy. These two approaches are compared here by means of decision analysis. The results indicate that an initial trial of corticosteroid therapy in the adult yields as many, or more, remissions, fewer complications, and lower mortality than does routine renal biopsy. A trial of corticosteroids is an acceptable first step in management of adults as well as children with nephrotic syndrome.