Abstract: TH-PO142

Initial States of Circulating Anti-Phospholipase A2 Receptor Antibody and Cigarette Smoking Predict a Clinical Outcome in Japanese Patients with Idiopathic Membranous Nephropathy

Session Information

Category: Glomerular

  • 1005 Clinical Glomerular Disorders

Authors

  • Hachiya, Asaka, Nagoya University Graduate School of Medicine, Nagoya, Japan
  • Akiyama, Shin'ichi, Nagoya University Graduate School of Medicine, Nagoya, Japan
  • Maruyama, Shoichi, Nagoya University Graduate School of Medicine, Nagoya, Japan
Background

Idiopathic membranous nephropathy (iMN) is the leading cause of nephrotic syndrome in adults, the clinical outcomes in iMN is difficult to predict. We reported that the prevalence of anti-PLA2R in Japanese patients with iMN is approximately 50%, which was lower than reports from any other countries (approx. 75%). In addition, we reported that cigarette smoking is a significant and dose-dependent risk factor for progression of Japanese patients with iMN. In this study, we had tried to reveal that the association of initial states of anti-PLA2R and cigarette smoking to clinical outcomes in Japanese patients with iMN.

Methods

We retrospectively enrolled consecutive 78 biopsy-proven iMN Japanese patients with nephrotic syndrome (# of male, 57; median age, 64 [IQR 60-70] years old; # of Current/Ex-smoker, 34) who admitted our hospitals between January 2003 and December 2012, and followed these patients for at least 3 months (median [IQR], 56 [35-81] months). All patients were not treated with any immunosuppressive therapies at renal biopsy, whose serum were collected at the same time of renal biopsy. Duration of complete remission (CR) and predictors of prolongation of CR were assessed and anti-PLA2R in serum was measured by ELISA.

Results

Anti-PLA2R was positive in 53% (41 of 78) of all patients with iMN. The prevalence of anti-PLA2R in current/ex-smokers (59%, 20 of 34) higher than that in never-smokers (47%, 21 of 44). In the follow-up period, CR was observed in 55 patients (anti-PLA2R positive, 27; negative, 28). In patients with anti-PLA2R positive and/or ex/current smoker, the period to CR tended to prolong. Duration of CR with anti-PLA2R positive and ex/current smoker was significantly longer than that of the other groups (log rank, p = 0.009). Multivariate Cox proportional hazards models revealed anti-PLA2R positive and current/ex-smokers (adjusted hazard ratio, 0.16 [95% confidence interval, 0.05–0.51]) associated with prolongation of CR.

Conclusion

The smoking experience and anti-PLA2R positive at diagnosis are risk factor for prolongation of complete remission. Our data suggested that check the initial states of circulating anti-PLA2R and cigarette smoking is useful and easy method to predict a clinical outcome of patient with iMN.