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2014 ; 25
(6
): 1357-66
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Phospholipase A2 receptor autoantibodies and clinical outcome in patients with
primary membranous nephropathy
#MMPMID24610926
Hoxha E
; Thiele I
; Zahner G
; Panzer U
; Harendza S
; Stahl RA
J Am Soc Nephrol
2014[Jun]; 25
(6
): 1357-66
PMID24610926
show ga
Membranous nephropathy (MN) is the most common cause of nephrotic syndrome in
adults, with an uncertain clinical outcome. The characterization of the
phospholipase A2 receptor (PLA2R) as the major target antigen in primary MN and
the detection of circulating autoantibodies in these patients is a major advance
in understanding this disease. To test whether PLA2R antibody levels reflect
disease activity or clinical outcome, we performed a prospective multicenter
study of 133 adult patients with primary MN and detectable serum PLA2R antibodies
who had not received immunosuppressive therapy. Patients were followed ?24
months. PLA2R antibody levels associated with clinical disease activity
(proteinuria) in patients with immunosuppressive therapy (n=101) or supportive
care (n=32). Within 3 months, immunosuppressive therapy led to a sustained 81%
reduction in PLA2R antibody levels paralleled by a 39% reduction in proteinuria.
Patients who experienced remission of proteinuria after 12 months had
significantly lower PLA2R antibody levels at the time of study inclusion compared
with patients with no remission. Patients with high PLA2R antibody levels
achieved remission of proteinuria significantly later than patients with low
PLA2R antibody levels. PLA2R antibody levels fell over time in patients with
spontaneous remission but remained elevated in patients who did not show a
reduction in proteinuria. Multivariable Cox regression analysis confirmed PLA2R
antibody level as an independent risk factor for not achieving remission of
proteinuria. We conclude that a decrease in PLA2R antibody level is associated
with a decrease of proteinuria in patients with primary MN.