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Clinical outcomes of immunosuppressive therapy in patients with seronegative anti-PLA2R antibodies and PLA2R-related membranous nephropathy

  • 0Department of Nephrology, Shenzhen Second People's Hospital, First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China.
Clinical and Experimental Nephrology +

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July 20, 2025

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July 20, 2025

View abstract on PubMed

Summary

This summary is machine-generated.

Immunosuppressive therapy improved remission rates in PLA2R-related membranous nephropathy patients who were negative for serum anti-PLA2R antibodies but had severe clinical features. This treatment may predict urine protein remission in this specific patient group.

Area Of Science

  • Nephrology
  • Immunology

Background

  • Membranous nephropathy (MN) is often associated with anti-PLA2R antibodies.
  • Investigating outcomes in PLA2R-antibody-negative MN is crucial for understanding disease heterogeneity.
  • The role of immunosuppressive therapy in this subgroup requires further elucidation.

Purpose Of The Study

  • To evaluate the impact of immunosuppressive therapy on clinical outcomes in patients with PLA2R-related MN and baseline negative serum anti-PLA2R antibodies.
  • To identify predictors of remission in this patient population.

Main Methods

  • Retrospective analysis of 133 patients with PLA2R-related MN.
  • Serum anti-PLA2R antibody levels measured by ELISA.
  • Renal biopsy analysis via light microscopy, immunofluorescence, and electron microscopy.
  • Comparison of outcomes between serum antibody-positive (SAb+/GAg+) and serum antibody-negative (SAb-/GAg+) groups.

Main Results

  • 49 patients (36.8%) were SAb-/GAg+; 84 (63.2%) were SAb+/GAg+.
  • The SAb-/GAg+ group showed significantly higher complete remission rates (67.35% vs. 33.33%) and lower relapse rates (12.24% vs. 36.90%).
  • In the SAb-/GAg+ group, immunotherapy (32.7%) improved overall remission rates compared to conservative treatment (75.76% vs. 100.00%, P=0.041) and predicted urinary protein remission (HR 3.92).

Conclusions

  • Patients with PLA2R-related MN and negative serum anti-PLA2R antibodies but positive glomerular antigen can achieve remission.
  • Immunosuppressive therapy may be beneficial for SAb-/GAg+ patients with severe baseline clinical manifestations.
  • Immunotherapy is a significant predictor of urinary protein remission in this subgroup.

Keywords:

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