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Kidney Week

Abstract: TH-PO999

Differences in Outcome in Patients with Membranous Nephropathy with and Without Anti-PLA2R Antibodies

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • van de Logt, Anne-Els, Radboud University Medical Center, Nijmegen, Netherlands
  • Justino, Joana, Institut de Pharmacologie Moleculaire et Celluleire, Sophia Abtipolis, France
  • Vink- van Setten, Coralien, Radboud University Medical Center, Nijmegen, Netherlands
  • van den Brand, Jan A.J.G., Radboud University Medical Center, Nijmegen, Netherlands
  • Lambeau, Gerard J., Institute of Molecular and Cellular Pharmacology, CNRS and University of Nice, Valbonne, France
  • Wetzels, Jack F., Radboud University Medical Center, Nijmegen, Netherlands
Background

The identification of autoantibodies against PLA2R1 (PLA2Rab) defined membranous nephropathy as an auto-immune disease. There is debate if outcome is different in PLA2Rab-positive and PLA2Rab-negative patients. We evaluated differences in the natural course of primary MN between PLA2Rab-positive and PLA2Rab-negative patients.

Methods

We included untreated patients with MN who were referred to our clinic between 1995 and 2016. Inclusion criteria were nephrotic range proteinuria (Upcr ≥ 3 gram/10 mmol) and a serum creatinine level of ≤ 135 µmol/l. Primary outcome was spontaneous remission, both partial and complete, or progression, defined as the need for immunosuppressive therapy because of an increase of serum creatinine level > 30% or severe persistent nephrotic syndrome. In stored samples PLA2Rab were measured with ELISA (Euroimmun®). A cut-off value of < 14 RU/ml was used to define seronegativity.

Results

In total 182 patients were included. PLA2Rab were detected in 75 % of patients. Clinical characteristics were similar between both groups (table 1). During follow-up, 65% of PLA2Rab-positive patients needed immunosuppressive therapy versus 48% of seronegative patients. At 60 months of follow-up, cumulative incidence of spontaneous remission was 52% vs 34% (p = 0.008) and progression was 43% vs 65% (p=0.02) for PLA2Rab-negative compared to positive patients.

Conclusion

The natural course of MN is more favorable in PLA2Rab-negative patients.

 aPLA2R pos
N= 136
aPLA2R neg
N=46
P value
Age (yrs)53 ± 1355 ± 170.449
Gender (% males)67 %65 %0.858
Screatinine (µmol/l)91 ± 1788 ± 200.303
Upcr (g/10 mmol)7.2 [5.5-10.9]7.8 [4.7-9.9]0.865
PLA2Rab titer (RU/ml)114 [53-228]--
Interval biopsy and measurement (mo)2.7 [1.2-9.1]2.6 [1.5-9.9]0.865