Anti-PLA2R Antibodies as a Prognostic Factor in PLA2R-Related Membranous Nephropathy.
BACKGROUND
The natural course of idiopathic membranous nephropathy (MN) varies, as it is known through favorable outcomes in most patients. However, one third of patients with idiopathic MN will slowly progress to end-stage renal disease (ESRD). To prevent disease progression, patients at high risk to develop ESRD are treated with immunosuppressive agents. Therefore, a correct selection of patients who need immunosuppressive treatment is important.


METHODS
Here, we evaluated the prognostic value of anti-phospholipase A2 receptor 1 antibody (anti-PLA2R) levels regarding clinical outcome in a well-defined cohort of 73 PLA2R-related MN patients with long-term follow-up. At baseline, patients were subdivided into patients with either low or high antibody levels based on ELISA testing.


RESULTS
Spontaneous remission rates were highest among patients with low anti-PLA2R levels (79%; hazard ratio 2.72 (95% CI 1.22-6.08), p = 0.02) after a median follow-up of 2.9 (95% CI 0.8-5.0, p < 0.001) years, whereas high anti-PLA2R levels were associated with persistent proteinuria (p = 0.04) and/or the need for immunosuppressive therapy (p < 0.001). Renal survival rates were 97% at 5 years, 93% at 10 years, and 89% at 15 years; however, this was not different between the anti-PLA2R groups. ESRD occurred significantly faster in patients with severe proteinuria as compared to patients with either mild (p = 0.02) or moderate proteinuria (p = 0.05).


CONCLUSIONS
Low anti-PLA2R levels may predict spontaneous remissions in patients with PLA2R-related MN. Therefore, we suggest that quantification of anti-PLA2R is of value to monitor these patients.
Departments of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, The Netherlands.
Sjoerd A M E G
SA
Timmermans
Myrurgia A
MA
Abdul Hamid
Jan Willem
JW
Cohen Tervaert
Jan G M C
JG
Damoiseaux
Pieter
P
van Paassen
D000328:Adult; D000368:Aged; D000906:Antibodies / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D015433:Glomerulonephritis, Membranous / Q000097:blood* / Q000150:complications / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011379:Prognosis; D011507:Proteinuria / Q000209:etiology; D054507:Receptors, Phospholipase A2 / Q000276:immunology*; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D015996:Survival Rate
D000906:Antibodies; D007166:Immunosuppressive Agents; C516360:PLA2R1 protein, human; D054507:Receptors, Phospholipase A2