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

Sales, Fernando; Carmo, Priscylla Vieira do; Huaira, Rosália Maria Nunes Henriques; Almeida, Nicolas William Gonçalves de; Lourenço, Mateus Henrique Toledo; Fernandes, Natália Maria da Silva

doi:10.1590/2175-8239-JBN-2024-0213en

home Sumário navigate_before Anterior Atual Seguinte navigate_next

home Sumário

Original Article • Braz. J. Nephrol. 47 (4) • Oct-Dec 2025 • https://doi.org/10.1590/2175-8239-JBN-2024-0213en linkcopy

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

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.

Keywords:
Cohort Studies; Renal Insufficiency, Chronic; Epidemiology; Glomerulonephritis; Pathology

Variable	Total	LN	IgAN	MN	FSGS	MCD	AAV	MPGN	Other^‡	Non-biopsied	p
Age* (Years, Mean, SD)	41.7 (14.4)	34.8 (10.6)	37.5 (12.2)	48.9 (14.7)	40 (15)	38.3 (13.2)	48.7 (14.9)	52.3 (17.4)	47.0 (14.4)	43.9 (14.3)	< 0.001
White People (%)	69.8	49.4	82.0	78.0	79.6	55.2	100	80	75.7	69.1	0.012
Women (%)	57.3	82.7	47.1	36.0	40.4	50.0	26.4	50.0	57.9	67.0	< 0.001
Hypertension (%)	78.2	81.5	92.2	90.0	88.5	63.3	63.6	100.0	65.8	64.9	< 0.001
Diabetes (%)	17.3	16.0	11.8	28.0	19.2	20.0	27.3	0.0	26.3	10.6	0.098
Dyslipidemia (%)	47.2	48.1	49.0	62.0	55.8	53.3	54.5	50.0	34.2	35.1	0.062
Cardiovascular diseases (%)	18.7	11.1	9.8	26.0	32.7	20.0	18.2	40.0	15.8	16.0	0.021
Current or former smoking (%)	29.7	9.9	31.4	46.0	32.7	30	54.6	70	39.5	24.5	< 0.001
Psychiatric disease (%)	39.6	49.4	33.3	16.0	36.5	56.7	36.4	50.0	31.6	45.7	0.004
Bone disease (%)	16.1	17.3	19.6	20.0	9.6	6.7	18.2	40.0	13.2	16.0	0.320
SBP initial* (mmHg, Mean, SD)	135.3 (23.7)	139.6 (26.5)	137.3 (21.9)	135.2 (27.2)	139.1 (21.9)	125.1 (12.7)	123.1 (11.9)	165.6 (28.9)	134.4 (22.9)	130.1 (20.7)	< 0.001
DBP initial* (mmHg, Mean, SD)	85.1 (14.5)	87.7 (16.8)	87.4 (13.0)	83.8 (13.9)	87.9 (13.7)	80.4 (10.1)	77.8 (10.4)	97.4 (14.0)	83.7 (13.4)	82.3 (14.5)	0.004
BMI initial* (% ≥25, kg/m²)	78.0	71.6	82.4	70	76.9	80	81.9	80	76.4	85.1	0.600
Antiproteinuric (%)	89.2	93.8	98.0	96.0	100.0	100.0	90.9	80.0	81.6	71.3	< 0.001
SGLT2i (%)	8.6	0.0	31.4	4.0	13.5	3.3	18.2	10.0	5.3	5.3	< 0.001
Diuretics (%)	73.4	77.8	46.0	92.0	84.6	93.3	45.5	100	59.0	52.1	< 0.001
Statins (%)	64.0	53.1	60.8	88.0	78.8	80.0	90.9	80.0	57.9	46.8	< 0.001
Imunossupression (%)	61.1	100.0	54.9	72.9	55.8	93.3	100.0	50.0	26.3	28.0	< 0.001
Corticosteroids (%)	59.0	100.0	54.9	60.0	55.8	93.3	100.0	50.0	23.7	26.6	< 0.001
IV Pulse therapy (%)	30.7	80.2	23.5	36.0	11.5	10.0	81.8	40.0	10.5	7.4	< 0.001
Nephrologic presentation (%)											< 0.001
Nephrotic syndrome	33.8	22.2	9.8	92.0	53.8	96.7	0.0	10.0	15.8	8.5
Nephritic syndrome	3.6	6.2	5.9	0.0	1.9	0.0	18.2	0.0	5.3	2.1
Nephritic-nephrotic syndrome	10.1	24.7	11.8	0.0	0.0	0.0	45.5	60.0	7.9	2.1
Isolated hematuria	7.2	0.0	2.0	0.0	0.0	0.0	9.1	0.0	7.9	26.6
Isolated subnephrotic proteinuria	14.9	12.3	9.8	4.0	25.0	0.0	0.0	0.0	23.7	24.5
Hematuria with subnephrotic proteinuria	24.2	17.3	58.8	2.0	13.5	0.0	18.2	30.0	34.2	33.0
Isolated nephrotic proteinuria	4.8	17.3	0.0	2.0	1.9	3.3	9.1	0.0	5.3	0.0
No data	1.4	0.0	2.0	0.0	3.8	0.0	0.0	0.0	0.0	3.2
Initial AKI (%)	15.5	21.5	21.6	8.0	11.5	10.0	70.0	30.0	21.1	5.3	< 0.001
RPGN (%)	8.7	20.3	9.8	0.0	3.8	0.0	60.0	10.0	13.2	1.1	< 0.001
Initial dialysis (%)	4.3	7.6	2.0	0.0	5.8	0.0	30.0	10.0	10.5	0.0	< 0.001
Family history present (%)	23.3	9.9	33.3	16.0	26.9	10.0	9.1	0.0	34.2	35.1	< 0.001

Variable	Total	LN	IgAN	MN	FSGS	MCD	AAV	MPGN	Other^‡	Non-biopsied	p
eGFR (Mean, SD)
Initial	72.9 (33.3)	79.7 (35.3)	60.0 (29.1)	78.1 (30.8)	67.8 (32.5)	91.8 (28.0)	54.5 (39.3)	42.6 (26.3)	65.3 (38.0)	76.3 (29.2)	< 0.001
Final	62.5 (33.0)	73.6 (34.8)	48.3 (28.0)	60.0 (32.8)	49.8 (28.5)	85.4 (24.7)	47.0 (32.5)	32.3 (15.7)	51.7 (31.7)	70.8 (30.8)	< 0.001
eGFR initial vs. final	p < 0.001
Proteinuria (Mean, SD)
Initial	3.7 (4.0)	2.9 (2.3)	2.9 (3.2)	7.9 (4.9)	5.0 (4.7)	7.6 (4.6)	2.1 (1.9)	3.3 (3.0)	2.6 (2.6)	1.3 (1.7)	< 0.001
Final	1.3 (2.1)	0.9 (1.9)	1.1 (1.3)	2.3 (2.9)	2.2 (2.2)	0.7 (1.5)	1.3 (1.3)	3.2 (5.2)	1.0 (1.0)	0.9 (2.0)	< 0.001
Proteinuria initial vs. final	p < 0.001
Number of biopsies (%)											< 0.001
1	87.0	75.3	94.1	94.0	92.3	83.3	81.8	90.0	89.5	–
≥2	13	24.7	5.9	6	7.7	16.7	18.2	10	10.5	–
Crescents (%)	23.8	45.5	21.1	0.0	0.0	0.0	100.0	20.0	16.7	–	< 0.001
% of IFTA (mean, SD)	20.0 (15.8)	15.0 (12.5)	20.0 (19.1)	20.0 (13.2)	20.0 (15.8)	5.0 (5.0)	30.0 (16.8)	17.5 (12.2)	37.5 (18.5)	–	0.25
Total or partial glomerular sclerosis (%)	69.3	54.9	88.1	51.4	100	46.7	85.7	71.4	54.5	–	< 0.001
Vascular injury (%)	44.4	28.6	50.0	47.7	63.6	21.1	62.5	37.5	44.4	–	0.010
Follow-up in months (median, IQR)	49.0 (12–99)	52.0 (19–66)	64.0 (13–124)	68.0 (24.3–134.5)	50.0 (18.8–99)	77.5 (24.8–124)	22.0 (4.5–57.5)	16.5 (12.3–29.5)	19.0 (7.5–77.5)	40.0 (10–80)	0.019
Clinical outcome (%)											0.002
Active in outpatient clinic	61.4	77.8	62.7	62.0	59.6	63.3	72.7	50.0	44.7	53.2
Loss to follow-up	22.3	13.6	17.6	22.0	15.4	33.3	9.1	10.0	31.6	31.9
Transfer to conservative CKD outpatient clinic	9.8	4.9	15.7	10.0	11.5	3.3	9.1	10.0	13.2	10.6
Dialysis	4.6	1.2	3.9	4.0	11.5	0.0	9.1	30.0	10.5	0.0
Death	1.2	2.5	0.0	2.0	1.9	0.0	0.0	0.0	0.0	1.1
Discharge from Nephrology follow-up	0.7	0.0	0.0	0.0	0.0	0.0	0.0	0.0	0.0	3.2

Cox regression analysis: outcome renal survival adjusted for confounders
	HR	95% CI	p
Age at diagnosis of GD	1.041	0.955–1.134	0.366
Sex feminine	0.163	0.022–1.211	0.076
Initial eGFR	0.956	0.920–0.994	0.023
Initial proteinuria	0.932	0.687–1.263	0.648
DM (diagnosis present)	0.985	0.153–6.348	0.988
Initial BMI	1.257	1.016–1.556	0.035
IFTA	1.079	1.020–1.142	0.008
ACE inhibitors or angiotensin receptor blocker (use)	83.3	0.420–16502.754	0.101
Immunosuppression (use)	0.626	0.080–4.881	0.655

vertical_align_top show_chart

more_horiz close
- image
- translate
- link
- article
- vertical_align_top
- file_download
- show_chart
- image
- translate
- link
- article

location_on

Sociedade Brasileira de Nefrologia Rua Machado Bittencourt, 205 - 5ºandar - conj. 53 - Vila Clementino - CEP:04044-000 - São Paulo SP, Telefones: (11) 5579-1242/5579-6937, Fax (11) 5573-6000 - São Paulo - SP - Brazil
E-mail: bjnephrology@gmail.com

rss_feed Acompanhe os números deste periódico no seu leitor de RSS

[T1FN1] Abbreviations – LN (Lupus Nephritis); IgAN (IgA Nephropathy); MN (Membranous Nephropathy); FSGS (Focal and Segmental Glomerulosclerosis; MCD (Minimal Change Disease); MPGN (Membranoproliferative Glomerulonephritis); AAV (ANCA-associated vasculitis); Other (Other glomerular disease: renal amyloidosis, monoclonal gammopathy of renal significance, glomerulonephritis associated with infection, normal biopsy with hematuria and/or subnephrotic proteinuria, fibrillary glomerulonephritis, non-IgA mesangial glomerulonephritis, crescentic glomerulonephritis not classified in previous glomerular diseases, thrombotic microangiopathy, no defined histological diagnosis); Non-biopsied (No kidney biopsy); SD (standard deviation); % (percentage); < (minor); ≥ (greater than or equal to); Cardiovascular diseases (Heart failure, or Coronary artery disease, or Cerebrovascular disease, or Peripheral arterial disease, or Rheumatic heart disease, excluding systemic arterial hypertension); SBP (systolic blood pressure); DBP (diastolic blood pressure); BMI (body mass index); Antiproteinuric (Angiotensin-converting enzyme inhibitors, or angiotensin II receptor blockers, or aldosterone blockers, or sodium-glucose cotransporter 2 inhibitors); SGLT2i (sodium-glucose cotransporter 2 inhibitors); Diuretics (loop diuretic, or thiazide diuretic, or aldosterone blocker); IV Pulse therapy (Intravenous Pulse Therapy); AKI (acute kidney injury); RPGN (rapidly progressive glomerulonephritis);

[T1FN2] *(at the beginning of the follow-up).