Here’s a startling revelation that challenges everything we thought we knew: primary glomerular diseases in children and young adults might not be as harmless as traditionally believed. In fact, some young patients may face an even faster decline in kidney function compared to older adults, raising urgent questions about how we approach their care. This groundbreaking research, set to be unveiled at ASN Kidney Week 2025 (November 5–9), flips the script on our understanding of these conditions.
But here’s where it gets controversial: while it’s rare to directly compare outcomes between pediatric and adult patients with primary glomerular diseases—such as minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS), membranous nephropathy (MN), and IgA nephropathy (IgAN)—the data tells a surprising story. Researchers dove into the CureGN study, one of the largest longitudinal cohort studies on glomerular diseases, and found that children and young adults often face similar or even higher risks of kidney failure, a significant drop in estimated glomerular filtration rate (eGFR), or death compared to older patients. And this is the part most people miss: pediatric patients with MCD, for instance, showed steeper eGFR declines than their adult counterparts.
The numbers don’t lie: MN patients aged 13–17 and FSGS or IgA nephropathy patients aged 18–44 experienced the sharpest eGFR declines within their respective groups. Interestingly, while patients with MCD, FSGS, and MN across all age groups shared similar risks of progressing to kidney failure, death, or a ≥40% eGFR decline, IgA nephropathy patients aged 6–12, 13–17, and 45–64 had lower risks compared to those aged 18–44. Is age truly a protective factor, or are we missing something critical in how we treat younger patients?
These findings paint a sobering picture: young patients diagnosed with primary glomerular diseases through kidney biopsy are at significant risk of facing kidney failure, dialysis, or even a transplant in their lifetimes. As Margaret Helmuth, MS, lead author from the University of Michigan, Ann Arbor, emphasizes, “Future studies are essential to fully understand the lifelong impact and morbidity of these diseases on young patients.”
Chia-shi Wang, MD, MSc, of Emory University School of Medicine, adds a critical point: “This research underscores why children must be included in clinical trials for these diseases. We can’t afford to leave them out if we want to improve their outcomes.”
But here’s the bigger question: Are we doing enough to address the unique challenges these young patients face? The study, titled ‘Glomerular Disease Outcomes Across the Lifespan: Report of the Cure Glomerulonephropathy (CureGN) Research Consortium,’ doesn’t just provide data—it sparks a necessary debate. Should treatment protocols for young patients be reevaluated? How can we better support this vulnerable population? We want to hear from you—do these findings align with your experiences, or do they challenge your assumptions? Let’s start the conversation in the comments below.
