Role of phospholipase A2 receptor 1 antibody level at diagnosis for long-term renal outcome in membranous nephropathy

• DOI: 10.1371/journal.pone.0221293
• Publication Date: 2019-09-09T17:28:45Z
• Authors: Maida Mahmud; Hans O. Pinnschmidt; Linda Reinhard; Sigrid Harendza; Thorsten Wiech; Rolf A. K. Stahl; Elion Hoxha
• Keywords: Membranous Nephropathy

Background Membranous nephropathy (MN) is an autoimmune disease induced by circulating antibodies against the podocyte protein phospholipase A2 receptor 1 (PLA2R1-ab) in 80% of patients and represents leading cause nephrotic syndrome adults. PLA2R1-ab levels correlate with activity treatment response. However, their predictive role for long-term renal outcome not clear. Methods The aim this prospective observational multicenter study was to investigate at time diagnosis a cohort 243 newly diagnosed biopsy-proven PLA2R1-associated MN. Statistical analyses included Cox proportional hazard models. primary endpoint defined prior data collection as doubling serum creatinine or development end-stage disease. Results During median follow-up 48 months, 36 (15%) reached endpoint. Independent predictors reaching were baseline (HR = 1.36, 95%CI 1.11–1.66, p 0.01), percentage tubular atrophy interstitial fibrosis 1.32, 1.03–1.68, 0.03), relapse during 3.22, 1.36–7.60, proteinuria 2.60, 1.17–5.79, 0.02). Fifty-four (22%) received no immunosuppressive study, 41 (76%) them spontaneously disappeared follow-up, 29 (54%) had complete remission proteinuria, 19 (35%) partial remission. Patients treated immunosuppression more often females lower levels, compared receiving immunosuppression. conclusion on efficacy therapies can be made, since randomized controlled decisions made per-protocol. Conclusions are, addition pre-existing damage, factors should therefore considered when deciding