Epidemiological profile and renal outcomes in a 25-year Brazilian cohort of glomerular diseases

巴西一项为期25年的肾小球疾病队列研究的流行病学特征和肾脏结局

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Abstract

INTRODUCTION: Glomerular diseases (GD) are an important cause of chronic kidney disease (CKD). This study aims to analyze the socio-demographic, clinical, and renal outcome profiles of patients with GD. METHODS: A retrospective cohort study was conducted between 1998 and 2023. Participants were patients aged ≥ 18 years, diagnosed with GD, and treated at a university hospital in Brazil. Socio-demographic, clinical, histopathological, and kidney variables were analyzed. A comparative analysis was performed among the most frequent histopathological diagnoses. Renal survival was the outcome variable. RESULTS: We evaluated 417 patients, of whom 57.3% were women and 69.8% were white. The mean age was 41.7 ± 14.4 years. Primary glomerular diseases (PGD) accounted for 51.1%, and 77.5% of patients underwent a kidney biopsy. The most frequent PGD was membranous nephropathy (26.3%), while among the secondary glomerular diseases (SGD), lupus nephritis (LN) was the most common (51.9%). Minimal change disease was associated with better renal survival, whereas membranoproliferative glomerulonephritis had the worst outcomes (p = 0.001). Regarding CKD progression, a higher initial estimated glomerular filtration rate (eGFR) was protective (HR = 0.956, 95%CI: 0.920-0.994; p = 0.023), while the presence of interstitial fibrosis/tubular atrophy (IFTA) (HR = 1.079, 95%CI: 1.020-1.142; p = 0.008) and a higher body mass index (BMI) (HR = 1.257, 95%CI: 1.016-1.556; p = 0.035) were associated with increased risk of CKD progression. CONCLUSION: LN remained the most common SGD in our region, while focal segmental glomerulosclerosis was the third most common PGD. Risk factors for worse outcome included a higher BMI, lower eGFR, and higher IFTA.

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