Garrity Kelly, Putnam Nathaniel, Kamil Elaine S, Massengill Susan, Khalid Myda, Srivastava Rachana, Isaacs Jaya, Salmon Eloise
Mattel Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Medical Univerity of South Carolina, Charleston, SC, USA.
Pediatr Nephrol. 2025 Jun;40(6):1949-1958. doi: 10.1007/s00467-024-06566-4. Epub 2024 Dec 27.
There is a lack of evidence to suggest that outcomes of adolescent and adult-onset glomerular disease differ. Still, most glomerular disease trials include adults but exclude adolescents.
We designed a retrospective study using the CureGN database to compare individuals with adolescent-onset glomerular disease relative to individuals with older and younger age at onset. The two main outcomes were sustained proteinuria remission off immunosuppression treatment and composite eGFR decline.
Our data did not show a significant difference in sustained proteinuria remission off treatment or composite eGFR decline between adolescent onset glomerular disease and either childhood (age 5-12), young adult (age 20-29), or adult (age 30-39) onset glomerular disease. Having high-risk APOL1 alleles and hypertension at the time of study enrollment decreased the likelihood of achieving sustained proteinuria remission off treatment. While participants with minimal change disease and IgA nephropathy were similarly likely to achieve sustained proteinuria remission off treatment, participants with focal segmental glomerulosclerosis and membranous nephropathy were less likely to achieve sustained proteinuria remission off treatment compared to participants with minimal change disease. CKD stage, high-risk APOL1 alleles, hypertension stage, and education all significantly impacted the likelihood of progression to the composite eGFR decline outcome.
Approximately 25% of each age cohort reached the composite eGFR decline outcome within 5 years. As more glomerular disease clinical trials become available, we must consider opening these trials to people with childhood and adolescent onset disease since like adults they are at high risk of progressive kidney function decline.
缺乏证据表明青少年起病和成人起病的肾小球疾病的预后存在差异。然而，大多数肾小球疾病试验纳入的是成年人，而排除了青少年。
我们利用CureGN数据库设计了一项回顾性研究，以比较青少年起病的肾小球疾病患者与起病时年龄较大和较小的患者。两个主要结局是免疫抑制治疗停药后持续蛋白尿缓解和综合估算肾小球滤过率（eGFR）下降。
我们的数据显示，青少年起病的肾小球疾病与儿童期（5 - 12岁）、青年期（20 - 29岁）或成人期（30 - 39岁）起病的肾小球疾病在治疗停药后持续蛋白尿缓解或综合eGFR下降方面没有显著差异。研究入组时具有高危APOL1等位基因和高血压会降低治疗停药后实现持续蛋白尿缓解的可能性。虽然微小病变病和IgA肾病的参与者实现治疗停药后持续蛋白尿缓解的可能性相似，但与微小病变病的参与者相比，局灶节段性肾小球硬化和膜性肾病的参与者实现治疗停药后持续蛋白尿缓解的可能性较小。慢性肾脏病（CKD）分期、高危APOL1等位基因、高血压分期和受教育程度均显著影响进展为综合eGFR下降结局的可能性。
每个年龄组中约25%的人在5年内达到了综合eGFR下降结局。随着更多肾小球疾病临床试验问世，我们必须考虑将这些试验向儿童期和青少年期起病的患者开放，因为他们与成年人一样，有肾功能进行性下降的高风险。
