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

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. 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. 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. 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.