Abstract: TH-PO140

Late Relapses of Membranous Nephropathy (MN)

Session Information

Category: Glomerular

  • 1005 Clinical Glomerular Disorders

Authors

  • Peleg, Yonatan A., New York Presbyterian-Columbia University Medical Center, New York City, New York, United States
  • Bomback, Andrew S., Columbia University, New York, New York, United States
  • Canetta, Pietro A., None, New York, New York, United States
  • Appel, Gerald B., Columbia University College of Physicians and Surgeons, Scarsdale, New York, United States
  • Ahn, Wooin, None, New York, New York, United States
Background

Most patients (pts) with MN who achieve remission carry a risk of relapse that diminishes over time. Relapse of disease after 5 years of sustained remission is considered a rare event.

Methods

We reviewed 15 idiopathic MN pts, who relapsed after a median time of 11 years of disease remission.

Results

10/15 pts were male. All were white, and one was Hispanic. Median age at diagnosis was 34 y (range 3-71). Median baseline eGFR was 79.4 ml/min/1.73m^2 (range 26.8-110). 9 went into complete remission (CR) and 6 pts went into partial remission (PR). CR was achieved with immunosuppression (IS) in 6 pts.

Median age at first relapse was 51 y (range 20-80), representing a gap of 11 y (range 6-36) from initial remission. Relapses presented as nephrotic syndrome in 8, while the other 7 were diagnosed by lab surveillance. 10/15 pts underwent repeat biopsy 12 y (range 8-33) after first biopsy: all showed pattern of primary MN. 12 pts received IS after relapse and 1 died prior to treatment. 8/14 surviving pts had PR after their initial relapse, 3 had CR, and 3 had no remission (NR). CR was not associated with IS use. 5 pts had additional relapse episodes after their first relapse, and all were treated with IS. Experiencing PR vs. CR did not predict risk of subsequent relapse. The results of the most recent relapse for these 5 patients are 1 in CR, 1 in PR, and 3 in NR. Median follow up duration was 19 y (range 9-56). The median most recent eGFR was 60.8 (range 16.8-105.6), and median yearly change in eGFR was -0.32 (range -2.73 to +2.82). None reached ESRD.

Of 10 available biopsies during clinical relapse, 6 were stained for PLA2R with all staining positive. Serum PLA2R Ab was tested in 10 pts, with some surveilled with serial titers: 2 had positive titers during relapse, 5 had negative titers during relapse, and 3 had negative values during PR. In all, 8/10 pts were positive for either tissue PLA2R or serum PLA2R Ab while in clinical relapse.

Conclusion

We present 15 MN pts with proteinuric relapse a median time of 11 years after initial remission. Repeat biopsies, even as long as 33 years after complete remission, all showed MN, and 80% of pts were PLA2R positive by tissue or serum testing. Thus repeat biopsy to reestablish a diagnosis of MN may be unnecessary. There was no significant decline in renal function despite relapses and median follow up time of 19 years.