Kidney Week

Abstract: TH-PO134

The Investigative Burden of Membranous Nephropathy in the UK

Session Information

• Clinical Glomerular Disorders: FSGS, MN, MCD
  November 02, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Glomerular

• 1005 Clinical Glomerular Disorders

Authors

• Wilson, Fiona, Manchester Royal Infirmary, Manchester, United Kingdom

Fiona Wilson,

• Hamilton, Patrick, NHS, Manchester, United Kingdom

Patrick Hamilton,

• Chinnadurai, Rajkumar, SALFORD ROYAL NHS FOUNDATION TRUST, Manchester, United Kingdom

Rajkumar Chinnadurai,

• Singh, Malinder, LTHTR, Preston, United Kingdom

Malinder Singh,

• Sinha, Smeeta, Salford Royal NHS Foundation Trust, Salford, United Kingdom

Smeeta Sinha,

• Kanigicherla, Durga A.K., Central Manchester University Hospitals, Manchester, United Kingdom

Durga A.K. Kanigicherla,

• Brenchley, Paul E., Manchester Royal Infirmary, Manchester, United Kingdom

Paul E. Brenchley,

Background

Membranous Nephropathy (MN) represents two distinct disease entities. Primary MN (PMN) is now recognized as an autoimmune condition associated with the anti-PLA₂R antibody and secondary MN occurs in tandem with malignancy, infection or drug therapy. Prior to the discovery of anti-PLA₂R antibody in 2009 and the development of accessible ELISAs, the diagnosis of MN was a diagnosis of exclusion. We investigated the investigative burden for patients with MN and the diagnostic yield of these tests

Methods

Patients from 2 UK centres with a diagnosis of MN between 2009 and 2014 were identified. Across the Northwest of England, anti-PLA₂R testing became readily available in 2012. Therefore patients were divided into those receiving a diagnosis 2009-2011 (pre-ELISA) and 2012-2014 (post-ELISA). Records were reviewed for the investigations which took place 6 months prior and 6 months following the biopsy date to see if these were normal or identified a secondary cause of MN. Investigations included viral and autoimmune screens, X-rays, CT, MRI, PET scan, ultrasound, upper and lower GI endoscopies and cystoscopies.

Hypothesis
The introduction of anti-PLA₂R testing leads to a modification of the investigative pathway for MN patients.

Results

121 patients were identified, 104 with PMN and 17 with secondary MN. Patients went through an average of 7.38 tests with only 18 of 893 (2.0%) tests proving to be instrumental in helping with the diagnosis of secondary versus primary MN. For patients diagnosed with PMN they had an average of 7.48 tests, all of which were negative. With the introduction of anti-PLA₂R testing in 2012 there appears to be a trend towards a reduction in the investigative profile of patients with the average number of tests falling from 7.73 to 7.29. A significant reduction was noted in Hepatitis B and C (p=0.029 for both) and colonoscopies (p=0.012). There was also a reduction in the total cost of investigation per patient with PMN from an average of £553.41 in 2009-2011 to £366.02 in 2012-2014.

Conclusion

Patients with a diagnosis of MN undergo multiple investigations, many of which are negative, at a significant cost to both the healthcare system and patients quality of life. The anti-PLA₂R test has the potential to reduce this burden as its use becomes more widespread.