Background: Idiopathic nephrotic syndrome (INS) is the most common form of podocytopathy in children. Although the dramatic response to steroid therapy, steroid resistance occurs in 10% to 30% of cases. Hemopexin is a plasma β-1 glycoprotein circulating in serum. Hemopexin has been discovered to influence glomerular basement membrane permeability to albumin. This study aimed to examine the relation between plasma hemopexin (Hx) and the course of idiopathic nephrotic syndrome and assess the relation between plasma hemopexin levels and steroid insensitivity. Patient and methods: This a case control study, included 39 children which were allocated to two groups A and B, in addition to the control group C. Group (A) included 13 newly diagnosed patients with steroid-resistant nephrotic syndrome (SRNS). Group (B) included 13 new patients with steroid-sensitive nephrotic syndrome (SSNS). The control group (Group C) included 13 normal children. All participants underwent full history taking, clinical examination, laboratory investigations, then whole blood samples were taken to estimate plasma hemopexin levels by ELISA technique. The statistical analysis done to interpret the results. Results: The plasma hemopexin level was higher in steroid resistant cases than in the steroid sensitive with a Signiant difference<0.001.Conclusions: Serum hemopexin level gives a predictive information about the course of INS, and produces a guide for nephrologists to prevent excessive glucocorticoid-induced toxicity and earlier switching to more effective substitute therapy.