GLOMERULAR DISEASES showed distinct sex differences in epidemiology, clinical presentation and age distribution in a nationwide analysis of 34,258 native kidney biopsies recorded in the Spanish Registry of Glomerulonephritis between 1994 and 2024.
The analysis examined biopsy data by sex, age and six-year study periods. All biopsies underwent light microscopy and direct immunofluorescence, with electron microscopy used when required. Researchers compared clinical presentations and major histological diagnoses between men and women.
Men accounted for 59.9% of biopsies, with this predominance remaining stable across the study periods. The findings indicated that men generally presented with higher serum creatinine, lower creatinine clearance and greater proteinuria.
Women were more likely to have asymptomatic urinary abnormalities, while men more frequently had chronic kidney disease at diagnosis. Asymptomatic urinary abnormalities were recorded in 25% of women compared with 19% of men, while chronic kidney disease was present in 17% of men compared with 12% of women (p<0.001).
The study also identified diagnosis-specific differences. Younger women were more frequently represented among patients with immunoglobulin A nephropathy and podocytopathies. Women with membranous nephropathy were more common in both the paediatric and oldest age groups.
Further differences emerged among patients with lupus nephritis and antineutrophil cytoplasmic antibody-associated vasculitis. Men with lupus nephritis presented with more aggressive clinical syndromes, while women with antineutrophil cytoplasmic antibody-associated vasculitis underwent biopsy with higher proteinuria and worse renal function.
The findings demonstrate persistent sex differences in glomerular diseases while highlighting substantial variation in clinical presentation across specific diagnoses and age groups.
The researchers indicated that incorporating sex-stratified analyses into registries and clinical studies is essential for improving diagnostic accuracy and supporting personalised nephrology. The nationwide biopsy data also suggest that sex should be considered alongside age and clinical presentation when interpreting patterns of glomerular disease.
These findings reinforce the value of examining glomerular diseases through a sex-specific lens, particularly where differences in renal function, proteinuria and presenting syndromes may influence clinical assessment.
Goicoechea M et al. Sex differences in epidemiology and clinical presentation of glomerular diseases in a nationwide Spanish biopsy registry. Sci Rep. 2026;DOI:10.1038/s41598-026-63453-8.
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