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.