Predictive value of the domain specific PLA2R antibodies for clinical remission in patients with primary membranous nephropathy: A retrospective study

• DOI: 10.1371/journal.pone.0302100
• Publication Date: 2024-05-08T17:36:40Z
• Authors: Kezhi Zhou; Junyi Zhou; Leting Zhou; Jing Xue; Bin Liu; Zhijian Zhang; Xiran Zhang; Ting Cai; Sijia Shao; Biao Huang; Yi Zhang; Zhigang Hu; Liang Wang; Xiaobin Liu
• Keywords: Membranous Nephropathy

Background M-type phospholipase A2 receptor (PLA2R) is a major auto-antigen of primary membranous nephropathy(PMN). Anti-PLA2R antibody levels are closely associated with disease severity and therapeutic effectiveness. Analysis PLA2R antigen epitope reactivity may have greater predictive value for remission compared total PLA2R-antibody level. This study aims to elucidate the relationship between domain-specific clinical outcomes PMN. Methods retrospective analysis included 87 patients PLA2R-associated Among them, 40 47 were treated rituximab (RTX) cyclophosphamide (CTX) regimen, respectively. The quantitative detection -immunoglobulin G (IgG)/-IgG4 targeting its in serum PMN obtained through time-resolved fluorescence immunoassays served as biomarkers evaluating treatment A possibility nomogram was developed using multivariate logistic regression analysis. Discrimination prediction model assessed area under receiver operating characteristic curve (AUC-ROC).Bootstrap ROC used evaluate performance model. Results After 6-month period, rates proteinuria, including complete partial RTX CTX groups, 70% 70.21% (P = 0.983), However, there significant difference immunological PLA2R-IgG4 groups (21.43% vs. 61.90%, P 0.019). Furthermore, we found differences PLA2R-CysR-IgG4(P 0.030), PLA2R-CTLD1-IgG4(P 0.005), PLA2R-CTLD678-IgG4(P 0.003), spreading 0.023) responders non-responders group. Multivariate showed that higher urinary protein (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.26–0.95; 0.035) PLA2R-CTLD1-IgG4 (OR, 0.79; 95%CI,0.62–0.99; 0.041) independent risk factors early remission. estimating presented nomogram. AUC-ROC our 0.721 (95%CI, 0.601–0.840), consistency results internal validation, which 0.711 0.587–0.824), thus, demonstrating robustness. Conclusions Cyclophosphamide can induce earlier than at span 6 months. has better predict PLA2R-IgG proteinuria th month.