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Temporal Association Between PLA2R Antibodies and Clinical Outcomes in Primary Membranous Nephropathy

R Ramachandran1, A K Yadav1, V Kumar1

  • 1Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Kidney International Reports
|January 18, 2018
PubMed
Abstract

Insights

In primary membranous nephropathy (PMN), decreasing autoantibodies to M-type phospholipase A2 receptor (aPLA2R) levels predict treatment response. Persistent aPLA2R indicates resistance to therapy.

Area of Science:

  • Nephrology
  • Immunology
  • Clinical Medicine

Background:

  • Autoantibodies to M-type phospholipase A2 receptor (aPLA2R) are present in 66% of primary membranous nephropathy (PMN) patients and correlate with disease activity.
  • The exact temporal relationship between aPLA2R levels, circulating autoantibodies, and clinical disease activity in PMN remains unclear.

Purpose of the Study:

  • To investigate the temporal association between serum aPLA2R levels and clinical activity during and after treatment in patients with PMN.

Main Methods:

  • A cohort of 30 PMN patients with elevated aPLA2R receiving immunosuppressive therapy were monitored.
  • Serum aPLA2R levels were measured monthly for 6 months; clinical data were collected for 9 months.
  • Serological remission was defined as two consecutive negative aPLA2R tests; clinical remission followed standard criteria.

Main Results:

  • 80% of patients achieved serological remission within 6 months, with 54% achieving it by month 1.
  • 67% of patients achieved clinical remission.
  • Serological remission occurred at a mean of 2.7 months, preceding clinical remission at a mean of 5.05 months.

Conclusions:

  • A reduction in circulating aPLA2R levels precedes clinical remission in aPLA2R-associated PMN.
  • Persistent aPLA2R levels at therapy completion are linked to resistance to treatment.
Keywords:
PLA2Rmembranous nephropathyproteinuriaserial monitoring

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