Andrew Vissing, MD, an attending physician and assistant professor at Northwestern University Feinberg School of Medicine.

Andrew Vissing, MD

 in glomerular disease outcomes among patients aged 14–25 years, clinicians may need to implement more frequent follow-ups to help young adults balance competing priorities.

“Care should always be individualized, but this age group often requires additional nuance. A 20-year-old with glomerular disease can vary widely in independence and ability to manage a complex medical condition,” explained Andrew Vissing, MD, an attending physician and assistant professor at Northwestern University Feinberg School of Medicine, in an interview with 

. “Early in diagnosis, these diseases often require close follow-up, and adolescents and young adults are at higher risk of being lost to follow-up because of competing life priorities.”

Findings from the Cure Glomerulonephropathy (CureGN) consortium in patients with 

focal segmental glomerulosclerosis (FSGS)

 highlight unique disease trajectories in this age group, including higher relapse rates, faster kidney function decline, and, in some cases, quicker remission.

These differences suggest clinicians should not rely on arbitrary age cutoffs but instead view adolescents and young adults as a distinct group requiring tailored monitoring and treatment strategies.

In the United States, an estimated 0.4% of adolescents aged 12–17 have some form of 

, with glomerular diseases accounting for roughly 18% of pediatric kidney disease cases and affecting thousands. Previous CureGN research suggested that approximately 25% of individuals with adolescent-onset glomerular disease reached the composite eGFR decline outcome within five years, reflecting an increased risk of disease progression compared with both younger and older patients.

Globally, glomerular disease affects millions, and incidence has been increasing over the past decades, highlighting the growing need for age-specific care models.

Adolescence and young adulthood are transitional periods, particularly for patients managing glomerular disease. The focus on newfound independence, social pressures, and adjusting to careers can push disease management to the background. Additionally, this period also often coincides with transitions from pediatric to adult care providers, which can disrupt continuity and contribute to missed appointments or delayed treatment adjustments.

From Vissing’s perspective, many patients in this age group may not initially grasp the seriousness of their disease. To address this, he implements shorter follow-up windows and frequently involves nurses or social workers to facilitate laboratory testing, medication access, and appointment adherence.

This approach of increased support and monitoring benefits patients struggling to manage their own care. At the same time, Vissing notes he finds some young adults are capable of independently managing their kidney health, highlighting the need for flexible care strategies tailored to each patient’s level of independence.

Another challenge for this population is limited access to newer therapies and clinical trial participation due to age-based cutoffs, typically set at 18 years. While this was not the focus of the study, Vissing emphasized it as an important area for improving care.

“Pediatric patients < 18 are often excluded from trials of new medications, and it can take years for approved adult therapies to become available to younger patients,” he said. “While this was beyond the scope of our study, it highlights an important gap for adolescents and young adults, particularly those who fall just under age-based eligibility thresholds despite potentially benefiting from these treatments.”

Taken together, these findings underscore the need for clinicians to develop structured follow-up plans, consider multidisciplinary support, and advocate for trial inclusion to optimize outcomes for this age group.

Editor’s Note: Vissing reports no relevant disclosures.

Vissing A, Fishbein J, Smith AR, et al. Is Age Just a Number? Kidney360. Published online December 23, 2025. doi:

Garrity K, Putnam N, Kamil ES, et al. Comparing adolescent glomerular disease clinical outcomes to the clinical outcomes in childhood, young adult, and adult-onset glomerular disease in the CureGN database. Pediatric Nephrology. Published online December 27, 2024. doi:

https://doi.org/10.1007/s00467-024-06566-4

Sun P, Ming X, Song T, et al. Global burden of chronic kidney disease in adolescents and young adults, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Frontiers in Endocrinology. 2024;15. doi:

https://doi.org/10.3389/fendo.2024.1389342

World Health Organization. Coming of age: adolescent health. www.who.int. Published 2024. 

https://www.who.int/news-room/spotlight/coming-of-age-adolescent-health

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Andrew Vissing shares his clinical perspective and strategies to mitigate gaps in care and management for young adults with glomerular disease.


Implementing Age-Specific Care For Young Adults With Glomerular Disease With Andrew Vissing, MD

Recent findings revealed differences in relapse rates and kidney function decline between adolescents and young adults with glomerular disease and older adult patients. 

However, these disparities might stem from a lack of understanding regarding age-specific care in these patient populations.

“Adolescents and young adults are often navigating major life transitions: finishing high school, starting college or a job, moving away from home, and developing independence,” said Andrew Vissing, MD, attending physician and assistant professor at Northwestern University Feinberg School of Medicine, in an interview with 

. “For patients with chronic diseases like glomerular disease, these transitions can make disease management more difficult. Prior studies in kidney transplantation have shown that this age group experiences worse outcomes than both younger children and older adults, which motivated us to explore whether similar patterns exist in glomerular disease.”

Data from the Cure Glomerulonephropathy (CureGN) consortium, a network of investigators studying glomerular diseases in pediatric and adult populations, underscored the need for age-differentiated care and outcome assessment in this patient population.

Glomerular disease affects millions worldwide, with >17 million individuals developing 

 secondary to glomerulonephritis in 2019. Since 1990, incident cases have increased by 77% and prevalent cases by 81%. In the United States, glomerulonephritis accounts for approximately 10–15% of all end-stage kidney disease (ESKD) and represents the third leading cause.

The most common forms of glomerular disease include

, all of which are associated with substantial morbidity and impaired quality of life.

According to CureGN investigators, glomerular disease outcomes are often defined using arbitrary age cutoffs, typically separating pediatric and adult populations at 18 years. The current analysis aimed to address this gap by defining adolescents and young adults as a distinct group when evaluating disease trajectories.

In minimal change disease (MCD), investigators observed several differences across age groups. Adults experienced fewer relapses compared with young adults (incidence rate ratio [IRR], 0.61; 95% Confidence Interval [CI], 0.41-0.91;

 = .01), whereas relapse rates did not differ between pediatric patients and young adults (IRR, 1.23; 95% CI, 0.85–1.79; 

 = .28). Pediatric patients with MCD also achieved first observed remission more rapidly than young adults (hazard ratio [HR], 2.18; 95% CI, 1.03-4.63; 

Among patients with IgAN, adults experienced fewer relapses than young adults (IRR, 0.55; 95% CI, 0.33-0.94; 

 = .03). Adults with IgAN were also slower to achieve first observed remission compared with young adults (HR, 0.58; 95% CI, 0.37=0.91; 

In FSGS, kidney function declined more rapidly among young adults, with an estimated decline of 1.7 mL/min/1.73 m² per year compared with 0.3 mL/min/1.73 m² per year in pediatric patients (

“One of the main takeaways is not any single outcome, but rather the consistent finding that adolescents and young adults experience different disease trajectories,” Vissing said. “This suggests that clinicians and researchers should not lump these patients into pediatric or adult categories based on an arbitrary age cutoff, but instead consider them as a distinct population.”

Vissing A, Fishbein J, Smith AR, et al. Is Age Just a Number? 

. Published online December 23, 2025. doi:

Balakrishnan S, Thongprayoon C, Craici IM, Cheungpasitporn W, Miao J. Global and national public awareness and interest in glomerular diseases from 2004 to 2024. 

https://doi.org/10.3389/fneph.2025.1519481

New CureGN findings and an interview with Andrew Vissing, MD, highlight distinct glomerular disease outcomes in adolescents and young adults compared with pediatric and adult patients


Andrew Vissing, MD

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