Sim JJ, et al. - Renal function decline, incident end-stage renal disease (ESRD), and mortality were compared among patients with 5 common glomerular diseases [focal segmental glomerulosclerosis (FSGS), membranous glomerulonephritis (MN), minimal change disease (MCD), immunoglobulin A nephropathy (IgAN), and lupus nephritis (LN)] in a large diverse population. Findings suggested significant differences in estimated glomerular filtration rate (eGFR) decline and ESRD risk among patients with 5 glomerulonephropathies. Different management strategies and expectations were thus justified with these variations in presentation and outcomes.

Methods

• From January 1, 2000, to December 31, 2011, researchers performed a retrospective cohort study (between) of patients with glomerulonephropathy using the electronic health record of an integrated health system.
• Among patients with 5 common glomerular diseases, eGFR change, incident ESRD, and mortality were compared.
• They used competing risk models to determine hazard ratios for different glomerulonephropathies for incident ESRD, with mortality as a competing outcome after adjusting for potential confounders.

Results

• Researchers identified 2350 patients with glomerulonephropathy (208 patients [9%] younger than 18 years) with a mean follow-up of 4.5±3.6 years.
• Among these, 497 (21%) progressed to ESRD and 195 (8%) died before ESRD.
• The median eGFR decline was 1.0 mL/min per 1.73 m² per year; this varied across different glomerulonephropathies (P<.001).
• They noted highest ESRD incidence (per 100 person-years) in FSGS 8.72 (95% CI, 3.93-16.72) followed by IgAN (4.54; 95% CI, 1.37-11.02), LN (2.38; 95% CI, 0.37-7.82), MN (2.15; 95% CI, 0.29-7.46), and MCD (1.67; 95% CI, 0.15-6.69).
• They noted that compared with MCD, hazard ratios (95% CIs) for incident ESRD were 3.43 (2.32-5.08) and 2.35 (1.46-3.81), 1.28 (0.79-2.07), and 1.02 (0.62-1.68) for FSGS, IgAN, LN, and MN, respectively.
• They noted no marked association between glomerulonephropathy types and mortality (P=.24).