Unmet Needs of Glomerular Disease in Young Adults, Adolescents With Andrew Vissing, MD

Recent findings highlighted differences in relapse rates, kidney function decline, and time to first observed remission among adolescents and young adults with glomerular disease compared with adult patients.1

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.1

Glomerular disease affects millions worldwide, with >17 million individuals developing chronic kidney disease (CKD) 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.2

The most common forms of glomerular disease include IgA nephropathy (IgAN), membranous nephropathy, and focal segmental glomerulosclerosis (FSGS), all of which are associated with substantial morbidity and impaired quality of life.1

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.1

“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 HCPLive. “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.”

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; P = .01), whereas relapse rates did not differ between pediatric patients and young adults (IRR, 1.23; 95% CI, 0.85–1.79; P = .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; P = .04).¹

Among patients with IgAN, adults experienced fewer relapses than young adults (IRR, 0.55; 95% CI, 0.33-0.94; P = .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; P = .02).¹

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 (P = .008).¹

“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.”

References

1. Vissing A, Fishbein J, Smith AR, et al. Is Age Just a Number? Kidney360. Published online December 23, 2025. doi:https://doi.org/10.34067/kid.0000001090

2. Balakrishnan S, Thongprayoon C, Craici IM, Cheungpasitporn W, Miao J. Global and national public awareness and interest in glomerular diseases from 2004 to 2024. Frontiers in Nephrology. 2025;5. doi:https://doi.org/10.3389/fneph.2025.1519481