Association between anti-PLA2R antibody status and clinical remission in primary membranous nephropathy: a systematic...

The anti-PLA2R antibody is a key biomarker for primary membranous nephropathy, and clarifying its association with clinical remission is crucial for optimizing prognostic assessment and clinical management. This study aimed to systematically evaluate the correlation between anti-PLA2R antibody status and clinical remission in patients with PMN.

Relevant cohort studies were systematically searched and strictly screened from domestic and international databases in accordance with predefined inclusion and exclusion criteria. A total of 12 eligible cohort studies involving 1664 PMN patients were included in this meta-analysis.

Pooled quantitative analysis showed that anti-PLA2R antibody-positive patients had a significantly lower clinical remission rate compared with seronegative counterparts. The pooled RR was 0.75 (95% CI 0.61-0.92), P = 0.007, indicating a statistically significant difference between the two groups. The test for subgroup differences showed marginally different effect sizes across the three groups (X² = 5.83, df = 2, P = 0.05), suggesting that divergent anti-PLA2R testing methods partly accounted for the overall high inter-study heterogeneity (I² = 71%).

Anti-PLA2R positivity predicts poorer 6-month remission in adult PMN, supporting KDIGO-guided early immunosuppression for high-risk patients. Heterogeneity mainly stems from inconsistent detection assays, and unified testing improves prognostic accuracy.