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Published on: December 17, 2017
Is Age Just a Number?: A Comparative Analysis of Glomerular Disease Across Ages from the Cure Glomerulonephropathy
Andrew Vissing1,2, Joseph Fishbein2, Abigail R Smith3
1Division of Nephrology and Hypertension, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Key Points:
Adolescents and young adults with glomerular disease have unique clinical features distinct from children and older adults. Patterns of relapse, remission, and changes in kidney function differ by age and glomerular disease type. Traditional pediatric-adult cutoffs often overlook key differences; care and research should reflect a continuum across the lifespan.
Background:
Glomerular disease (GD) is a prominent cause of kidney disease in adolescents and young adults (AYAs), yet there is limited information on how this population fares compared with children and older adults.
Methods:
We analyzed data from Cure Glomerulonephropathy, a prospective cohort of patients of all ages with biopsy-proven GD. Patients with minimal change disease (MCD), FSGS, and IgA nephropathy (IgAN) were included. Patients were stratified into pediatric (≤13), AYA (14-25), and adult (≥26) groups and compared by demographic, clinical, and disease characteristics. Associations between age group and relapse rate, change in kidney function, and time to remission were assessed using multivariate negative binomial, linear mixed effects, and Cox proportional hazards models, respectively, stratified by disease type.
Results:
Our study included 1868 patients (562 pediatric, 397 AYA, and 909 adults). The median follow-up time was 4.9 years. Adults with MCD had fewer relapses (incidence rate ratio [IRR], 0.61; 95% confidence interval [CI], 0.41 to 0.91; P = 0.01), while there was no difference between pediatric participants with MCD (IRR, 1.23; 95% CI, 0.85 to 1.79; P = 0.28) compared with AYA. Adults with IgAN had fewer relapses than AYA (IRR, 0.55; 95% CI, 0.33 to 0.94; P = 0.03). AYA had faster decline in kidney function compared with pediatric participants with FSGS (1.7 versus 0.3 ml/min per 1.73 m 2 per year, P = 0.008) and IgAN (1.5 versus 0.1 ml/min per 1.73 m 2 increase per year, P = 0.002). Pediatric participants with MCD achieved first observed remission sooner compared with AYA (hazard ratio, 2.18; 95% CI, 1.03 to 4.63; P = 0.04). Adults with IgAN were slower to achieve first observed remission compared with AYA (hazard ratio, 0.58; 95% CI, 0.37 to 0.91; P = 0.02).
Conclusions:
AYA with GD exhibit distinct clinical patterns compared with the pediatric and adult age groups, underscoring the need to approach care and research along an age-related continuum rather than a binary framework.
