Membranous Nephropathy Outcomes Among Children and Adults: Cure Glomerulonephropathy Study (CureGN)
Bibliographic record
Abstract
Background: Membranous nephropathy (MN) is a rare entity in children, whereas it’s one of the most common causes of primary nephrotic syndrome in adults. There are limited data on disease progression in children, as well as uncertainty about differences between childhood vs adult-onset MN. Methods: CureGN is a multi-center prospective, observational cohort of individuals with biopsy-proven glomerular diseases. For this analysis, baseline clinical data and proportion of time on immunosuppression (IS) across study follow up were reported. Cox proportional hazard models were used to estimate time to kidney outcomes, and linear mixed models to assess estimated glomerular filtration rate (eGFR) trajectories. Models were adjusted for sex, age at biopsy, IS prior to biopsy, urine protein to creatinine ratio (UPCR), eGFR, and time from biopsy to enrollment. Results: Among 608 MN participants (580 with ≥1 follow-up visit), 54 (9%) had childhood-onset MN (age <18 at time of biopsy) with characteristics including: 48% female, median age 14 years (IQR, 12-17), and 15% self-identify as Black. Overall, childhood-onset MN had an increased risk of end stage kidney disease (HR, 5.1; 95% CI, 1.45-18) in comparison to adults. The eGFR decline was steeper in children (-3.75 (±0.87) ml/min/1.73m2 per year) than adults (-0.14 (±0.78) ml/min/1.73m2 per year) (p<0.0001). Conclusions: Despite potential for remission, children with MN had steeper eGFR decline and faster time to kidney failure than adults. Additional data are needed to extend our understanding of determinants of disease and outcomes to guide therapies and inform practice guidelines. Funding: NIDDK Support - Children (n=54) Adults (n=554) Enrollment Median eGFR (ml/min/1.73m2, IQR)* 107 (91-122) 77 (50-98) Median UPCR (mg/mg, IQR) 1.5 (0.4-5.3) 2.9 (0.9-6.6) Follow-up Follow-up time (years, IQR) 4.7 (3.0-6.4) 4.4 (2.4 -6.0) Proportion of time off IS (%) 57 74 *CKiD-U25 if age <25 year, CKD-EPI-2021 if age ≥ 25 years
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".