\u201cPrior studies in kidney transplant patients show adolescents and young adults have worse outcomes,\u201d Vissing told Healio. \u201cHowever, there is limited data on outcomes for young adults with glomerular disease, which is why we decided to study this.\u201d<\/p>\n
The researchers evaluated data from the Cure Glomerulonephropathy Network prospective cohort of 1,868 patients with biopsy-proven glomerular disease, including minimal change disease, focal segmental glomerulosclerosis (FSGS) and immunoglobulin A nephropathy (IgAN). The cohort was divided into three age groups: pediatric (30%; aged 13 years), adolescent\/young adult (21%; aged 14-25 years) or adult (49%; aged 26 years). <\/p>\n
The primary outcomes were associations between age and relapse rate, change in eGFR and time to first observed remission. Median follow-up time was 4.9 years.<\/p>\n
Results differed based on disease type. <\/p>\n
Minimal change disease was the most common glomerular disease in pediatric patients (50%) while IgAN was most common for adolescent\/young adult (44%) and adult populations (42%). <\/p>\n
Adults with minimal change disease reported fewer relapses (incidence rate ratio [IRR] = 0.61; 95% CI, 0.41-0.91) compared with adolescent\/young adult patients with minimal change disease. No significant differences were reported between pediatric and adolescent\/young adult patients with minimal change disease. However, pediatric patients with minimal change disease had their first observed remission earlier than adolescent\/young adult patients with minimal change disease (HR = 2.18; 95% CI, 1.03-4.63). <\/p>\n
No significant differences in relapse rates were found for FSGS. However, adolescents\/young adults with FSGS reported faster decline in kidney function compared with pediatric patients (1.7 mL\/min\/1.73 m\u00b2 per year vs. 0.3 mL\/min\/1.73 m\u00b2).<\/p>\n
For those with IgAN, adults had fewer relapses than adolescents\/young adults with IgAN (IRR = 0.55; 95% CI, 0.33-0.94) and were slower to reach first observed remission (HR = 0.58; 95% CI, 0.37-0.91). Adolescents\/young adults with IgAN had a significantly faster decline in kidney function compared with pediatric patients with IgAN (1.5 mL\/min\/1.73 m\u00b2 per year vs. 0.1 mL\/min\/1.73 m\u00b2).<\/p>\n
\u201cOur hypothesis was that adolescents and young adults with glomerular disease would have worse outcomes; however, I was surprised to see that this was not always the case,\u201d Vissing said. <\/p>\n
Overall, the results showed adolescents\/young adults with glomerular diseases present with distinct clinical profiles compared with pediatric and adult populations, according to the researchers.<\/p>\n
\u201cFrom my personal experience caring for this group, adolescent and young adult care needs to be tailored in a way that is different from how nephrologists are used to caring for older or younger patients,\u201d Vissing said.<\/p>\n
Future research could explore more distinct age profiles, such as groups aged 14 to 18 years and aged 19 to 25 years, to better understand these differences, according to Vissing.<\/p>\n
\u201cI believe some adolescent and\/or young adult distinction is important in clinical and research settings as opposed to an arbitrary cutoff at age 18 [years],\u201d he said.<\/p>\n
For more information:<\/h2>\n Andrew Vissing, MD,<\/b> can be reached at nephrology@healio.com. <\/p>\n\n
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Perspective<\/h2>\n Back to Top
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This interesting study by Vissing and colleagues provides valuable insight for nephrologists who care for patients with glomerular disease. Its findings underscore that adolescents and young adults comprise a distinct population with unique biologic, developmental and clinical characteristics that affect clinical trajectories. Adolescent and young adult patients demonstrated differences in relapse rates, kidney function decline and remission patterns compared with both younger children and adults, highlighting the need for developmentally informed care strategies.<\/default:p>As a pediatric nephrologist, these results reinforce the stark reality of what I often observe clinically: The transition from childhood into adolescence and young adulthood is marked by rapid physiological changes, evolving autonomy, shifting family dynamics and increased responsibility for disease self-management. These developmental milestones can complicate adherence and continuity of care and all too often lead to poor clinical outcomes. The study\u2019s evidence that adolescent and young adult patients occupy an intermediate \u2014 but distinctly vulnerable \u2014 position along the disease spectrum emphasizes the limitations of rigid pediatric-adult cutoffs.<\/default:p>Importantly, this manuscript underscores an opportunity for internal medicine-pediatric nephrologists and integrated transition clinics to play a pivotal role in improving outcomes. The dual training, and often close connections between adult and pediatric institutions, allows them uniquely to bridge pediatric and adult nephrology, offering continuity of care, developmental insight and familiarity with health system transitions. Coupled with innovative, holistic care models, such as multidisciplinary transition clinics, coordinated behavioral health support, and structured self-management programs, these approaches could meaningfully improve outcomes for patients navigating this high-risk period.<\/default:p><\/p>\n\n
Darcy K. Weidemann, MD, MHS, FAAP<\/strong><\/p>\n\nHealio | Nephrology News & Issues Editorial Advisory Board Member<\/li>\n Pediatric nephrologist<\/li>\n Children\u2019s Mercy<\/li>\n Kansas City, Missouri\n <\/li>\n<\/ul><\/div>\n
Disclosures: <\/strong> Weidemann reports no relevant financial disclosures.
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