This study retrospectively investigates the indications and results of renal biopsy in children to determine the patterns of childhood kidney disease in a single tertiary children's hospital in Egypt. We included all the patients who underwent ultrasound-guided renal biopsy from 1998 to 2012. All the kidney biopsies were studied under light microscopy, while immunofluorescence and electron microscopy were performed when indicated. A total of 1246 renal biopsies were performed over 15 years, on 1096 patients. The mean age of the patients at the time of biopsy was 9.2±3.7 years. The main indication for a biopsy was the steroid-resistant nephrotic syndrome (n=354, 28.4%), followed by the atypical nephrotic syndrome (n=250, 20.1%), and renal abnormalities in the systemic diseases (n=228, 18.3 %). In the 1226 pathologically diagnosed specimens, primary glomerulonephritis was the most common finding (n=826, 67.4%), followed by secondary glomerulonephritis (n=238, 19.4%). The most common causes of primary glomerulonephritis were Minimal Change Disease (MCD) (n=267, 21.8%), diffuse proliferative glomerulonephritis (n=188, 15. 3%), and focal proliferative glomerulonephritis (n=164, 13.3%). Lupus nephritis (n=209, 17%) was the most common cause of secondary glomerulonephritis. We conclude that the steroid-resistant nephrotic syndrome was the most frequent indication for biopsy and minimal change disease was the most common histopathological finding in our population.