Anti-phospholipase A2 receptor antibody levels at diagnosis predicts spontaneous
remission of idiopathic membranous nephropathy
#MMPMID28396737
Jullien P
; Seitz Polski B
; Maillard N
; Thibaudin D
; Laurent B
; Ollier E
; Alamartine E
; Lambeau G
; Mariat C
Clin Kidney J
2017[Apr]; 10
(2
): 209-214
PMID28396737
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Background: The diagnostic role of circulating anti-phospholipase A2 receptor
antibodies (anti-PLA2R Abs) is now well recognized in idiopathic membranous
nephropathy (iMN). These Abs could also be interesting as predictors of clinical
outcome. In this study, we explored the prognostic value of anti-PLA2R Abs
measured in a cohort of iMN patients, with a special focus on their ability to
detect patients achieving spontaneous remission. Methods: All adult patients with
biopsy-proven iMN diagnosed between 1978 and 2007 were retrospectively screened
in our centre. Using a validated enzyme-linked immunosorbent assay, levels of
anti-PLA2R Abs were measured from serum samples obtained at the time of renal
biopsy and stored at?-80°C until processing. Clinical data on disease activity,
treatments and outcomes were collected by reviewing patients' medical records.
The association between anti-PLA2R Ab titres and clinical activity/outcome was
assessed by Cox proportional hazard and Kaplan-Meier methods. Results: In this
retrospective study, 68 patients were included in the final analysis (median
follow-up of 81 months). No significant association was found between anti-PLA2R
Ab titres at diagnosis with baseline proteinuria, baseline estimated glomerular
filtration rate or chronic kidney disease progression. Spontaneous remission was
observed in 22% of patients. Ab titres were significantly and gradually
correlated in a dose-response manner with the likelihood of spontaneous
remission. Conclusions: While Ab titres measured at diagnosis were not found to
predict the activity of iMN, evaluation of anti-PLA2R Ab titres might prove
useful in the early identification of patients likely to achieve spontaneous
remission.
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