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Abstract: TH-PO1000

Levels of Anti-PLA2R Antibodies Predictive of Renal Prognosis in Japanese Patients with PLA2R-Associated Primary Membranous Nephropathy

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

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

Measurement of circulating levels of autoantibody against phospholipase A2 receptor (PLA2R) antibody at diagnosis is important for not only differentiation but also for prediction of renal prognosis. Recent studies suggest that a poor renal outcome mainly occurs in patients with PLA2R-associated primary membranous nephropathy (pMN) who have a high level of anti-PLA2R antibody (aPLA2R-Abs) at diagnosis. This study investigated the association between aPLA2R-Abs levels and renal prognosis in Japanese patients with PLA2R-associated pMN.

Methods

We retrospectively enrolled 53 consecutive Japanese patients with biopsy-proven PLA2R-associated pMN (males, 38; median age, 64 [IQR 53-69] years old; observation period, 62 [43-91] months, urinary protein levels, 5 [4-9] g/day) admitted to our hospitals between January 2003 and December 2012. The primary outcome was the cumulative rate of 1.5-fold increase in serum creatinine and all-cause death. Sera were collected at the time of renal biopsy. We identified the levels of aPLA2R-Abs predictive of renal prognosis on the basis of C-index calculated with Cox proportional hazards models.

Results

Median levels of aPLA2R-Abs at diagnosis were 62 [IQR 32-165] RU/ml. Patients with ≥50 RU/ml (35 of 53) showed lower renal survival rates and more reached the outcomes compared to those with <50 RU/ml (17 of 35 vs. 1 of 18, p=0.01). Patients with ≥50 RU/ml also showed significantly lower serum albumin at baseline and received more frequent remission-induction immunosuppressive therapies (p<0.01, p=0.01, respectively). Cox proportional hazards models indicated that a level of ≥50 RU/ml at diagnosis predicted poor renal prognosis (adjusted hazard ratio by age, sex, urinary protein levels and use of immunosuppressive agents within 1 year, 8.3 [95% confidence interval 1.1–62.5, p=0.01]).

Conclusion

APLA2R-Abs levels of ≥50 RU/ml at diagnosis could help predict poor renal prognosis in Japanese patients with PLA2R-associated pMN.