{"doi":"10.2215/cjn.0000000707","title":"Proteinuria Trajectory and Disease Progression in Children and Adults with IgA Nephropathy/Vasculitis","abstract":"Key Points Defining risk of kidney function loss in IgA nephropathy and IgA vasculitis with nephritis is important for patient counseling and risk-based enrollment of clinical trials. Proteinuria trajectory over 2 years can uniquely identify patients at risk of loss of kidney function or kidney failure. Children and adults with the highest levels of proteinuria had a higher risk of progressive kidney disease compared with those with intermediate levels. Background Identifying patients with IgA nephropathy at risk of disease progression is critical for clinical decision making, risk-based patient counseling, and optimal enrollment of clinical trials. Methods Patients with IgA nephropathy and IgA vasculitis with nephritis were enrolled in the Cure Glomerulonephropathy Network, a multicenter observational cohort study. Children and adults were analyzed separately in four cohorts: ( 1 ) full, ( 2 ) incident, ( 3 ) prevalent, and ( 4 ) histology. Groups were defined using latent class trajectory modeling using proteinuria measurements over 2 years. Linear mixed models were used to calculate predicted eGFR slope. In adults, Cox proportional hazard models were used to model time to kidney failure or 40% eGFR decline as a function of the proteinuria trajectory group. Results Of 919 patients with IgA nephropathy/IgA vasculitis with nephritis enrolled into the Cure Glomerulonephropathy Network, 368 adults and 234 children were included in the analysis. In the full adult cohort, group 1 had the lowest levels of proteinuria (interquartile range [IQR], 0.1–0.4 g/g), while groups 2 and 3 had intermediate and higher levels of proteinuria (IQR, 0.5–1.5 and IQR, 1.8–4.1 g/g), respectively. The average predicted time to eGFR <15 ml/min per 1.73 m 2 was >90, 16, and 8 years and >90, 67, and 11 years for proteinuria trajectory groups 1, 2, and 3 in the full adult and pediatric cohorts, respectively. In adults, adjusting for age, eGFR at enrollment, immunosuppression exposure, and hypertension, group 3 membership was associated with 3.13 (95% confidence interval [CI], 1.84 to 5.33), 1.98 (95% CI, 0.97 to 4.06), and 3.36 (95% CI, 1.59 to 7.13) times higher hazard of progressing to a composite outcome compared with group 2 membership in the full, prevalent, and histology cohorts, respectively, but not associated with progression in the incident cohort. Conclusions Proteinuria trajectory is a major predictor of disease progression in patients with IgA nephropathy.","journal":"Clinical Journal of the American Society of Nephrology","year":2025,"id":511247,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":16,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9592,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1369856,"name":"A. Carver","orcid":null,"position":1,"is_corresponding":false},{"id":758462,"name":"Margaret Helmuth","orcid":"0000-0003-3311-3223","position":2,"is_corresponding":false},{"id":319587,"name":"Abigail R. Smith","orcid":"0000-0001-5496-4460","position":3,"is_corresponding":false},{"id":29431,"name":"Richard Lafayette","orcid":"0000-0003-3906-7934","position":4,"is_corresponding":false},{"id":929660,"name":"Prasanth Ravipati","orcid":"0000-0002-4184-941X","position":5,"is_corresponding":false},{"id":322857,"name":"Andrea L. Oliverio","orcid":"0000-0002-1735-7706","position":6,"is_corresponding":false},{"id":240578,"name":"Dana V. Rizk","orcid":"0000-0002-6877-2811","position":7,"is_corresponding":false},{"id":42064,"name":"Jan Novák","orcid":"0000-0002-9211-6670","position":8,"is_corresponding":false},{"id":242656,"name":"Francesca Lugani","orcid":"0000-0002-4189-8561","position":9,"is_corresponding":false},{"id":1089884,"name":"Sharon Bartosh","orcid":"0000-0002-4475-9751","position":10,"is_corresponding":false},{"id":242630,"name":"Krzysztof Mucha","orcid":"0000-0002-6613-7638","position":11,"is_corresponding":false},{"id":58245,"name":"Krzysztof Kiryluk","orcid":"0000-0002-5047-6715","position":12,"is_corresponding":false},{"id":923329,"name":"Manish K. Saha","orcid":null,"position":13,"is_corresponding":false},{"id":247047,"name":"Cynthia C. Nast","orcid":"0000-0001-8243-9073","position":14,"is_corresponding":false},{"id":355885,"name":"Jean Hou","orcid":"0000-0002-0361-0483","position":15,"is_corresponding":false},{"id":743433,"name":"Laura Biederman","orcid":"0000-0002-8877-7281","position":16,"is_corresponding":false},{"id":1369116,"name":"Nidia Messias","orcid":"0009-0009-4396-8840","position":17,"is_corresponding":false},{"id":235991,"name":"Avi Z. Rosenberg","orcid":"0000-0003-2356-950X","position":18,"is_corresponding":false},{"id":247058,"name":"Heather N. Reich","orcid":"0000-0001-8951-5518","position":19,"is_corresponding":false},{"id":240855,"name":"Pietro A. Canetta","orcid":"0000-0003-1130-5486","position":20,"is_corresponding":false},{"id":251778,"name":"Patrick H. Nachman","orcid":"0000-0002-5890-2862","position":21,"is_corresponding":false},{"id":416320,"name":"Carla Nester","orcid":"0000-0002-0629-7576","position":22,"is_corresponding":false},{"id":1083831,"name":"Raed Bou-Matar","orcid":"0000-0001-5029-8712","position":23,"is_corresponding":false},{"id":1369117,"name":"Shikha Wadhwani","orcid":"0000-0002-0005-2340","position":24,"is_corresponding":false},{"id":29420,"name":"Laura H. Mariani","orcid":"0000-0002-6055-764X","position":25,"is_corresponding":false},{"id":514719,"name":"Myda Khalid","orcid":"0000-0002-0613-3790","position":26,"is_corresponding":false},{"id":1369857,"name":"on behalf of the CureGN IgA Working Group","orcid":null,"position":27,"is_corresponding":false},{"id":758463,"name":"Dorey A. Glenn","orcid":"0000-0003-2796-3037","position":0,"is_corresponding":true}],"reference_count":32,"raw_metadata":null,"created_at":"2026-07-19T02:47:55.918021Z","pmid":"40208688","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}