Abstract: TH-PO999
Differences in Outcome in Patients with Membranous Nephropathy with and Without Anti-PLA2R Antibodies
Session Information
- Glomerular Diseases: Clinical, Outcomes, Trials - I
October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
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 ± 13 | 55 ± 17 | 0.449 |
| Gender (% males) | 67 % | 65 % | 0.858 |
| Screatinine (µmol/l) | 91 ± 17 | 88 ± 20 | 0.303 |
| 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 |