Kidney Week

Abstract: FR-PO0823

Subtyping in Patients with Glomerular Disease by eGFR and Urine Protein-to-Creatinine Ratio (UPCR)

Session Information

• Glomerular Diseases: Practice and New Concepts Shaping Modern Care
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Schutte, Alexander W., Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States

Alexander W. Schutte, MS

• Banker, Margaret, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States

Margaret Banker, PhD

• Khalid, Myda, Indiana University School of Medicine, Indianapolis, Indiana, United States

Myda Khalid, MD, FASN

• Smith, Abigail R., Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States

Abigail R. Smith, PhD

Group or Team Name

• the Cure Glomerulonephropathy Network (CureGN)

Background

Treatment challenges in glomerular disease stem from heterogeneity in histology from unknown mechanistic causes. This study aimed to identify subgroups of pediatric and adult glomerular disease using common markers of disease progression and activity.

Methods

Pediatric and adult participants with biopsy-proven MCD, FSGS, MN, and IgA enrolled in the prospective observational cohort study CureGN within 5 years of biopsy were included. Summary metrics of eGFR and UPCR in the first 2 years post-enrollment, age, and time from biopsy to enrollment were modeled using principal components analysis followed by k-means clustering separately for children and adults. Clusters were characterized and differences in long-term risk of kidney failure were assessed by Kaplan-Meier curves and unadjusted hazard ratios.

Results

662 children and 1,344 adults yielded 3 clusters each. Cluster 1 in both groups showed faster disease progression (median [IQR] eGFR slope -9.26 [-25.12 - 11.18] ml/min/1.73m²/yr, ped; -7.31 [-15.40 - 2.64] ml/min/1.73m²/yr, adult) and higher time-averaged UPCR (median [IQR] 8.96 [5.20 – 12.70] g/g, pediatric; 7.37 [5.54 – 9.88] g/g, adult). This cluster was predominately FSGS (50%) in pediatrics and MN (63%) in adults and exhibited higher rates of hematuria (88% ped; 61% adult) and hypertension (79% peds; 67% adult). In pediatrics the other 2 clusters had substantially lower hazard of kidney failure compared to this cluster (HR 0.07 and 0.13, p<0.001), while in adults cluster 3 had a larger magnitude hazard reduction than cluster 2 (HR=0.04 vs. 0.53) compared to cluster 1 (Figure, p<0.01).

Conclusion

This analysis identified clusters with fast progressing disease in children and adults across different histopathologic diagnoses. Additional analysis into genetic and histopathologic features could identify mechanistic explanations for these differences in disease progression.

Funding

• NIDDK Support