title: Anti-phospholipase A₂ receptor antibodies in recurrent membranous nephropathy.
abstract: About 70% of patients with primary membranous nephropathy (MN) have circulating anti-phospholipase A2 receptor (PLA2R) antibodies that correlate with disease activity, but their predictive value in post-transplant (Tx) recurrent MN is uncertain. We evaluated 26 patients, 18 with recurrent MN and 8 without recurrence, with serial post-Tx serum samples and renal biopsies to determine if patients with pre-Tx anti-PLA2R are at increased risk of recurrence as compared to seronegative patients and to determine if post-Tx changes in anti-PLA2R correspond to the clinical course. In the recurrent group, 10/17 patients had anti-PLA2R at the time of Tx versus 2/7 patients in the nonrecurrent group. The positive predictive value of pre-Tx anti-PLA2R for recurrence was 83%, while the negative predictive value was 42%. Persistence or reappearance of post-Tx anti-PLA2R was associated with increasing proteinuria and resistant disease in 6/18 cases; little or no proteinuria occurred in cases with pre-Tx anti-PLA2R and biopsy evidence of recurrence in which the antibodies resolved with standard immunosuppression. Some cases with positive pre-Tx anti-PLA2R were seronegative at the time of recurrence. In conclusion, patients with positive pre-Tx anti-PLA2R should be monitored closely for recurrent MN. Persistence or reappearance of antibody post-Tx may indicate a more resistant disease.
authors.affiliation: Department of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
authors.forename: A
authors.initials: A
authors.lastname: Kattah
authors.forename: R
authors.initials: R
authors.lastname: Ayalon
authors.forename: L H
authors.initials: LH
authors.lastname: Beck
authors.forename: S
authors.initials: S
authors.lastname: Sethi
authors.forename: D G
authors.initials: DG
authors.lastname: Sandor
authors.forename: F G
authors.initials: FG
authors.lastname: Cosio
authors.forename: M J
authors.initials: MJ
authors.lastname: Gandhi
authors.forename: E C
authors.initials: EC
authors.lastname: Lorenz
authors.forename: D J
authors.initials: DJ
authors.lastname: Salant
authors.forename: F C
authors.initials: FC
authors.lastname: Fervenza
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D005260:Female; D015433:Glomerulonephritis, Membranous / Q000276:immunology*; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000601:surgery*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011507:Proteinuria / Q000276:immunology; D054507:Receptors, Phospholipase A2 / Q000737:chemistry* / Q000276:immunology*; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D054507:Receptors, Phospholipase A2
keywords: Clinical research; glomerular biology and disease; kidney transplantation; nephrology; practice; recurrent disease