Nephrotic syndrome is a set of symptoms primarily characterized by daily protein loss in the urine exceeding 3.5 grams, which can be caused by a range of underlying conditions. The presented case of an 88-year-old patient with nephrotic syndrome illustrates the challenges associated with the diagnostic process and treatment of this disorder in the presence of multiple comorbidities and advanced age. Despite contraindications for biopsy and, consequently, the lack of histological findings, treatment was initiated, resulting in significant partial remission, marked by a substantial reduction in proteinuria, decreased creatinine levels, and a satisfactory eGFR. This case highlights the importance of treating nephrotic syndrome in elderly patients and demonstrates the possibility of effective therapy despite diagnostic difficulties arising from contr aindications for renal biopsy.