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Negative anti-phospholipase A2 receptor antibody status at three months predicts remission in primary membranous
Gabriel Stefan1,2, Simona Stancu1,2, Adrian Zugravu1,2
1University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.
Background:
The value of anti-phospholipase A2 receptor antibody (anti-PLA2R ab) monitoring at 3 months after diagnosis in membranous nephropathy (MN) remains uncertain.
Methods:
We retrospectively examined the outcome on 1 August 2020 of 59 adult patients (age 54 (44, 68) years, 69% male, SCr 1.0 (0.9, 1.3) mg/dL) diagnosed with MN (kidney biopsy, positive serum anti-PLA2R ab). The outcomes were: kidney survival; partial and/or complete remission.
Results:
Most of the studied patients (97%) received immunosuppression, cyclophosphamide regimens were the most frequent (87%), followed by cyclosporine (10%). The median time to remission was 12.0 months and the cumulative remission rates were 34% at 6, 54% at 12, and 73% at 24 months. Forty (69%) patients had negative anti-PLA2R ab at 3 months, they had similar age, serum creatinine, albumin, proteinuria, and treatment with the group with positive ab at 3 months. In the Cox proportional hazard model, three months anti-PLA2R ab negativization (HR 0.4 (95%CI 0.1, 0.9)) was an independent predictor for remission, while baseline hypoalbuminemia (HR 3.0 (95%CI 1.5, 5.7)) was associated with absence of remission. Six (10%) patients died, mostly due to cardiovascular disease and infections. A total of five (9%) patients started dialysis. Mean kidney survival time was 50.3 months and there was no survival difference in relation to baseline anti-PLA2R ab titer (p .09) or 3 months negativization (p .8).
Conclusions:
Three months anti-PLA2R ab negativization seems to be a late predictor of remission, and lower serum albumin at diagnosis is an early marker for remission absence. Abbreviations: anti-P LA2R ab, anti-phospholipase A2 receptor antibody; eGFR, estimated glomerular filtration rate; ESKD, end stage kidney disease; MN, membranous nephropathy; NELL-1, neural epidermal growth factor-like 1 protein; RAAS: renin-angiotensin-aldosterone system; RBC: red blood cells; RRT, renal replacement therapy; T HSD7A, thrombospondin type-1 domain containing 7A.
Insights
Monitoring anti-phospholipase A2 receptor antibody (anti-PLA2R ab) levels at three months can predict remission in membranous nephropathy (MN). Lower serum albumin at diagnosis is an early indicator of poor remission outcomes in MN patients.
Area of Science:
- Nephrology
- Immunology
- Internal Medicine
Background:
- The prognostic value of anti-phospholipase A2 receptor antibody (anti-PLA2R ab) monitoring at 3 months in membranous nephropathy (MN) requires clarification.
- Membranous nephropathy is a leading cause of nephrotic syndrome in adults.
Purpose of the Study:
- To evaluate the utility of 3-month anti-PLA2R antibody monitoring as a predictor of remission in MN.
- To identify early markers associated with remission absence in MN.
Main Methods:
- Retrospective analysis of 59 adult MN patients diagnosed with positive serum anti-PLA2R antibodies.
- Outcomes assessed included kidney survival and partial/complete remission.
- Cox proportional hazard models were used to identify predictors of remission.
Main Results:
- Anti-PLA2R antibody negativization at 3 months was an independent predictor of remission (HR 0.4).
- Lower serum albumin at diagnosis was associated with absence of remission (HR 3.0).
- Remission rates were 34% at 6 months, 54% at 12 months, and 73% at 24 months.
Conclusions:
- Three-month anti-PLA2R antibody negativization serves as a late predictor for remission in MN.
- Low serum albumin at diagnosis is an early marker indicating a lower likelihood of remission in MN patients.
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