# A retrospective single-center cohort study of major subtypes of primary glomerular diseases (MN, IgAN, and MCD): clinical characteristics, prognostic outcomes, and risk factors

## TL;DR

This study examines three common kidney diseases, identifying clinical features and risk factors affecting treatment outcomes and disease progression.

## Contribution

The study identifies specific risk factors and clinical outcomes for three primary glomerular diseases using a single-center cohort.

## Key findings

- 24-hour urinary protein and LDL levels were significant factors for proteinuria remission.
- Hypertension history and mesangial sclerosis were risk factors for kidney disease progression.
- Disease duration was a risk factor for progression in membranous nephropathy patients.

## Abstract

This study aims to investigate patients with the three major types of primary glomerular diseases who underwent kidney biopsy at our center, with the objectives of characterizing their clinical phenotypes and pathological features, and identifying risk factors for clinical outcome events.

Between January 2013 and December 2023, consecutive patients diagnosed with membranous nephropathy (MN), immunoglobulin A nephropathy (IgAN), and minimal change disease (MCD) by kidney biopsy were included in this retrospective follow-up study. Outcome measures included proteinuria remission and kidney disease progression events. Multivariate-adjusted Cox proportional hazards models were utilized.

A total of 608 patients were included in the follow-up cohort, comprising 438 with MN, 110 with IgAN, and 60 with MCD. Clinical remission was achieved in 481 (79.1%) patients, including 333 (54.8%) with complete remission (CR) and 148 (24.3%) with partial remission (PR). Kidney disease progression occurred in 79 (13.0%) patients. After balancing for baseline data and pathological diagnoses in relation to different outcomes, 24-h urinary total protein (24 h-UTP; ≥ 3.5 g/d vs. < 3.5 g/d: HR 1.35, 95% CI 1.10–1.64, p = 0.003), low-density lipoprotein (LDL; HR 0.91, 95% CI 0.86–0.96, p < 0.001), pathological diagnoses (MN vs. MCD: HR 0.68, 95% CI 0.50–0.92, p = 0.011), and interstitial fibrosis and tubular atrophy (IFTA) were significantly associated with proteinuria remission. History of hypertension (HR 2.37, 95% CI 1.32–4.25, p = 0.004), and the presence of nodular mesangial sclerosis (HR 1.79, 95% CI 1.01–3.16, p = 0.045) were identified as independent risk factors for kidney disease progression. A significant interaction was observed between disease duration and pathological diagnoses. Subgroup analysis indicated that longer disease duration was an independent risk factor for kidney disease progression in patients with MN (HR 1.04, 95% CI 1.01–1.07, p = 0.013).

Undertaken at a single center, this study outlines the spectrum of current treatments, clinical outcomes, and factors influencing these outcomes among patients newly diagnosed with the three principal glomerular diseases through kidney biopsy.