Objective To investigate the pathological distribution of pediatric renal diseases through renal biopsy analysis, thereby informing clinical diagnosis and treatment strategies. Methods The pathological data of children who underwent renal biopsy during the period from 2009 to 2022 were collected and analyzed to assess the pathological types and their characteristics. Results A total of 3 496 patients were included, with a male predominance. In infants and young children, primary glomerular diseases and hereditary kidney disorders were predominant, while secondary glomerular diseases increased significantly after school age. Primary glomerular diseases comprised 63.8% in total, with minimal change disease being the most common (42.7%), followed by IgA nephropathy (26.3%), mesangial proliferative glomerulonephritis (13.5%), and focal segmental glomerulosclerosis (7.3%). Secondary glomerular diseases accounted for 33.4%, with Henoch-Schönlein purpura nephritis (HSPN) representing 86.4% of these cases, and lupus nephritis accounting for 12.9%. Among the 60 cases of hereditary kidney diseases, Alport syndrome was the most common, accounting for 71.7%. Conclusion In the Zhejiang area, primary glomerular diseases predominate among children's kidney disorders, with minimal change disease being the most prevalent pathological type. Among secondary glomerular diseases, Henoch-Schönlein purpura nephritis is the most common. Congenital and hereditary factors should be closely monitored for infants and young children with kidney diseases.