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. 2025 Mar 24;10(6):1917-1928.
doi: 10.1016/j.ekir.2025.03.027. eCollection 2025 Jun.

Risk Factors for Disease Progression for Adults and Children With Membranous Nephropathy in the Cure Glomerulonephropathy Network (CureGN)

Louis-Philippe Laurin  1   2 , Margaret Helmuth  3 , Salem Almaani  4 , Isabelle Ayoub  4 , Dhruti P Chen  5 , Leonela A Villegas  6 , Cynthia C Nast  7 , Bruce M Robinson  3 , Vimal K Derebail  5 , Meryl Waldman  8 , Andrew S Bomback  9 ; CureGN Consortium
Collaborators, Affiliations

Risk Factors for Disease Progression for Adults and Children With Membranous Nephropathy in the Cure Glomerulonephropathy Network (CureGN)

Louis-Philippe Laurin et al. Kidney Int Rep. .

Abstract

Introduction: Primary membranous nephropathy (pMN) is a frequent cause of nephrotic syndrome in adult patients without diabetes. Recognizing the major shift in the classification of pMN based on target antigen and the management of patients with pMN with more widespread use of rituximab (RTX), we sought to better characterize the clinical course and risk factors in adults and children with pMN.

Methods: We used the Cure Glomerulonephropathy (CureGN) prospective cohort of patients with pMN diagnosed using biopsy between 2010 and 2023. We report time to kidney outcomes using adjusted Cox proportional hazards models.

Results: In total, 591 patients (537 adults and 54 children) were evaluated with 9% reaching kidney failure. Anti-B cell therapy was used in 44% of patients. Age < 18 years, self-reported Black/African American race, proteinuria > 3 g/g, and lower estimated glomerular filtration rate (eGFR) at enrollment were associated with worse kidney survival. Black race (adjusted hazard ratio [HR]: 1.8; 95% confidence interval [CI]: 1.1-2.9) and age < 18 years (adjusted HR: 3.7; 95% CI: 2.0-7.1) were associated with an increased risk of kidney failure and/or > 40% eGFR decline after adjusting for exposure to immunosuppression. Latinx ethnicity was associated with a lower likelihood of reaching complete proteinuria remission (adjusted HR: 0.4; 95% CI: 0.2-0.7).

Conclusion: This study unveils self-reported Black race, young age (aged < 18 years) and Latinx ethnicity as potential risk factors associated with worse kidney outcomes.

Keywords: clinical outcomes; cohort study; immunosuppression; membranous nephropathy; risk factors.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Study Flowchart. ESKD, end-stage kidney disease; FSGS, focal segmental glomerulosclerosis; IgAN, IgA nephropathy; IgAV, IgA vasculitis; MN, membranous nephropathy; NEPTUNE, Nephrotic Syndrome Study Network.
Figure 2
Figure 2
Antiphospholipase A2 receptor (PLA2R) antibody measurements in CureGN. Forty-three percent of antiPLA2R antibody measurements were performed while patients were in active disease. PLAR2, phospholipase A2 receptor.
Figure 3
Figure 3
Kidney survival curves (outcome: kidney failure) stratified by self-identified Black race.
See this image and copyright information in PMC

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