Younger Age at Glomerular Disease Diagnosis Linked to Greater Lifetime Risk Despite Similar Progression Rates

A new cohort study has found that patients with primary glomerular disease (GD) face similar risks for declines in kidney function regardless of the age at disease diagnosis, highlighting a higher risk of progression for younger patients.1

Findings from the study were presented at the American Society of Nephrology (ASN) Kidney Week 2025, held November 5-9, 2025, in Houston, Texas, by study investigator Margaret Helmuth, MS, Biostatistician, University of Michigan, Ann Arbor.

“Direct comparisons of outcomes between adult and pediatric patients with primary glomerular disease are rare. We compared disease outcomes among patients with minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS), membranous nephropathy (MN), and IgA nephropathy (IgAN) across the lifespan,” Helmuth and colleagues wrote.1

GD, including MCD, FSGS, MN, and IgAN, are leading causes of kidney failure worldwide, often requiring lifelong monitoring and intervention. While disease mechanisms and treatment responses are known to vary by age, there has been limited data directly comparing long-term outcomes between pediatric and adult patients across these subtypes. Understanding whether age at diagnosis influences disease trajectory could help refine follow-up strategies and identify patients at greatest lifetime risk for kidney failure.

Wang and colleagues compared disease outcomes among 2915 patients from the Cure Glomerulonephropathy (CureGN) Research Consortium enrolled from centers in North America and Europe and followed for at least 1 year. Participants had MCD, FSGS, MN, and IgAN across lifespans. Investigators examined risk of death, end-stage kidney disease (ESKD), and ≥40% estimated glomerular filtration rate (eGFR) decline below 60ml/min/1.73m2, with age at biopsy as the primary predictor. Analyses were stratified by histologic subtype and adjusted for sex, race/ethnicity, proteinuria at biopsy, and eGFR at biopsy in multivariable Cox regression. The study included 647 participants with MCD, 738 with FSGS, 636 with MN, and 894 with IgAN. Participants had a median of 5.6 years of follow-up (IQR, 2.1-7.6).1

The investigators found that pediatric participants with MCD had steeper eGFR declines (range, -0.6 to -1.3 mL/min/1.73m2) compared to adults (range, -0.4 to 0.5 mL/min/1.73m2). Participants with MN aged 13-17 years and participants with FSGS and IgAN aged 18-44 years at the time of biopsy had the steepest declines in eGFR among their diagnosis cohorts.1

“These findings suggest that young patients who obtained a kidney biopsy diagnosis of primary glomerular disease face significant risk of reaching kidney failure and requiring dialysis and / or a transplant in their lifetimes. We believe that future studies are needed to shed light on the lifetime burden and morbidity of primary glomerular diseases on patients diagnosed at a young age,” Helmuth said in a statement.2 “Our research also highlights the importance of including children in clinical trials for disease treatment to mitigate against the adverse outcomes they face,” added co-author Chia-shi Wang, MD, MSc, of the Emory University School of Medicine.

Across participants with MCD, FSGS, and MN, Wang and colleagues found no differences between the various age groups in the risk of progression to the composite outcome of death, ESKD or ≥40% eGFR decline. Notably, participants with IgAN aged 6-12 years (hazard ratio [HR], 0.33; 95% CI, 0.17-0.62), 13-17 years (HR, 0.44; 95% CI, 0.24-0.81), and 45-64y (HR, 0.64; 95% CI, 0.43-0.96), had lower risks of progression compared to those aged 18-44 years.1

“Patients with primary GD face similar risks for declines in kidney function regardless of the age at disease diagnosis. For younger patients, this represents a higher likelihood of reaching ESKD and requiring dialysis and/or transplant in their lifetimes,” Helmuth and colleagues wrote.1

References

1. Helmuth M, Smith AR, Modi ZJ, et al. Glomerular Disease Outcomes Across the Lifespan: Report of the Cure Glomerulonephropathy (CureGN) Research Consortium. Presented at: ASN Kidney Week. Houston, Texas. November 05-09, 2025. #FR-OR030

2. Study Uncovers Glomerular Disease Outcomes Across the Lifespan. News release. ASN. November 7, 2025. https://www.newswise.com/articles/study-uncovers-glomerular-disease-outcomes-across-the-lifespan