Kidney Week

Abstract: FR-PO0832

Association of Nephrotic Syndrome Disease Activity with Thromboembolism in the CureGN and NEPTUNE Cohorts

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

• Kowalczyk, Sonya R., The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States

Sonya R. Kowalczyk, MD

• Liu, Qian, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States

Qian Liu, MPH

• Zee, Jarcy, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States

Jarcy Zee, PhD, FASN

• Kerlin, Bryce A., The Ohio State University Wexner Medical Center, Columbus, Ohio, United States

Bryce A. Kerlin, MD

• Raffini, Leslie, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States

Leslie Raffini, MD, MSc

• Denburg, Michelle, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States

Michelle Denburg, MD

Background

Thromboembolism (TE) is a life-threatening complication of nephrotic syndrome (NS). In this study, we evaluated the association of time-varying markers of NS disease activity with time to TE.

Methods

We performed a retrospective cohort study of two glomerular disease studies, CureGN and NEPTUNE, and excluded patients with history of TE prior to enrollment. TE status was assessed at each study visit, with the diagnosis date recorded for all confirmed events. Time-dependent Cox proportional hazards regression evaluated the association of disease activity markers (UPCR, serum albumin, and eGFR) with time to TE, adjusting for enrollment age, race, histology, disease activity markers, and steroid prescription.

Results

3,392 participants were included with median age of 27 years (IQR 12-49) and biopsy diagnoses: 786 (23%) minimal change disease, 870 (26%) FSGS, 629 (19%) membranous nephropathy, and 945 (28%) IgA nephropathy. Over a median follow-up of 4.5 years (IQR 2.1-7.5), 90 TE events occurred (0.57 per 100 person-years). Cox models demonstrated HR of 1.15 (95% CI 1.09-1.22) per 1 mg/mg increase in UPCR and HR of 0.87 (95% CI 0.79-0.95) per 10 ml/min/1.73m² increase in eGFR. Compared to serum albumin <2.5 g/dL, albumin of 2.5-3.5 was associated with HR of 0.37 (95% CI 0.19-0.73) and albumin >3.5 g/dL was associated with HR of 0.18 (95% CI 0.10-0.35).

Conclusion

This study demonstrated that time-varying NS disease activity markers are independently associated with time to TE. These findings highlight the importance of monitoring for TE during high-risk periods and consideration of prophylactic anticoagulation in patients with more active disease.

Hazards associated with time-varying NS disease activity markers and time to TE

Funding

• NIDDK Support