title: Spontaneous remission of proteinuria is a frequent event in phospholipase A2 receptor antibody-negative patients with membranous nephropathy.
abstract: BACKGROUND
  Phospholipase A2 receptor antibodies (PLA2R-Ab) and thrombospondin type-1 domain-containing 7A antibodies (THSD7A-Ab) are present in 70-80% of patients with membranous nephropathy (MN). Little, however, is known about the pathogenesis of MN and the clinical outcome in PLA2R-Ab- and THSD7A-Ab-negative patients.
  
  
  METHODS
  In this prospective multicentre observational study, the clinical outcome of 37 patients with biopsy-proven MN who were negative for PLA2R-Ab and THSD7A-Ab in the serum was analysed.
  
  
  RESULTS
  A total of 198 patients were screened for inclusion in the study. Of these, 157 patients were positive for PLA2R-Ab and 4 patients for THSD7A-Ab. The remaining 37 patients were negative for both antibodies were and included in this study. Six patients died during the follow-up, five because of malignant diseases and one of an infection. One patient went into end-stage renal disease, and two patients were lost to follow-up. The remaining 28 patients were followed for at least 24 months (35.6 ± 8.9 months). Seventeen patients received immunosuppressive (IS) therapy, and 11 received supportive care only. At the end of the follow-up, 14 of the 17 patients treated with immunosuppressants and 10 of 11 patients on supportive therapy had a remission of proteinuria. The time to reach remission of proteinuria and serum creatinine levels at the end of the follow-up were not different between both groups. A univariate Cox regression analysis indicated that the use of immunosuppression did not alter the chance to reach a remission of proteinuria.
  
  
  CONCLUSIONS
  A high number of PLA2R-Ab- and THSD7A-Ab-negative patients with MN have a good prognosis and might not need IS therapy.
authors.affiliation: III. Medizinische Klinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Elion
authors.initials: E
authors.lastname: Hoxha
authors.affiliation: III. Medizinische Klinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Sigrid
authors.initials: S
authors.lastname: Harendza
authors.affiliation: Institut für Medizinische Biometrie & Epidemiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Hans O
authors.initials: HO
authors.lastname: Pinnschmidt
authors.affiliation: III. Medizinische Klinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Nicola M
authors.initials: NM
authors.lastname: Tomas
authors.affiliation: Nierenregister, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Udo
authors.initials: U
authors.lastname: Helmchen
authors.affiliation: III. Medizinische Klinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Panzer
authors.affiliation: III. Medizinische Klinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Rolf A K
authors.initials: RA
authors.lastname: Stahl
mesh_terms: D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000097:blood*; D005260:Female; D015433:Glomerulonephritis, Membranous / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011507:Proteinuria / Q000209:etiology / Q000503:physiopathology*; D054507:Receptors, Phospholipase A2 / Q000276:immunology*; D012075:Remission, Spontaneous; D019699:Thrombospondins / Q000276:immunology*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001323:Autoantibodies; D054507:Receptors, Phospholipase A2; C546399:THSD7A protein, human; D019699:Thrombospondins
keywords: PLA2R-Ab negative; membranous nephropathy; outcome