Kidney Research and Clinical Practice (Sep 2018)

Anti-phospholipase A2 receptor antibody as a prognostic marker in patients with primary membranous nephropathy

  • Eun Joo Song,
  • Kye Hwa Jeong,
  • Young Ae Yang,
  • Jeong-Hoon Lim,
  • Hee-Yeon Jung,
  • Ji-Young Choi,
  • Jang-Hee Cho,
  • Chan-Duck Kim,
  • Yong-Lim Kim,
  • Sun-Hee Park

DOI
https://doi.org/10.23876/j.krcp.2018.37.3.248
Journal volume & issue
Vol. 37, no. 3
pp. 248 – 256

Abstract

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Background: Phospholipase A2 receptor (PLA2R) has been identified as a major autoantigen in primary membranous nephropathy (MN). We evaluated the association between anti-PLA2R antibodies and clinical outcome in Korean patients with primary MN. Methods: A total of 66 patients with biopsy-proven MN were included. Serum level of anti-PLA2R antibodies was measured by enzyme-linked immunosorbent assay. Biochemical parameters were estimated initially and at follow-up. Results: Anti-PLA2R antibodies were detected in 52.1% and 27.8% of patients with primary and secondary MN, respectively. Forty-eight patients with primary MN were grouped based on presence or absence of anti-PLA2R antibodies. Proteinuria was more severe in anti-PLA2R-positive patients than in anti-PLA2R-negative patients (urine rotein/creatinine ratio 7.922 ± 3.985 g/g vs. 4.318 ± 3.304 g/g, P = 0.001), and anti-PLA2R antibody level was positively correlated with proteinuria. The incidence of chronic kidney disease stage ≥ 3 was higher in anti-PLA2R-positive patients compared with anti-PLA2R-negative patients (P = 0.004). The probabilities of spontaneous remission were higher in anti-PLA2R-negative patients compared with anti-PLA2R-positive patients (P⟨ 0.001). Multivariate analysis demonstrated that anti-PLA2R antibodies are an independent risk factor for developing chronic kidney disease stage ≥ 3 and for not reaching spontaneous remission. Conclusion: Detection of anti-PLA2R antibodies at diagnosis in patients with primary MN can predict prognosis and guide treatment decisions.

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