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Abstract: SA-PO343

Relation Between Anti-PLA2R Titer and the Likelihood of Spontaneous Remission in Membranous Nephropathy

Session Information

Category: Glomerular Diseases

  • 1202 Glomerular Diseases: Immunology and Inflammation

Authors

  • Jatem, Elias A., Hospital Universitari Arnau de Vilanova, Lleida, Spain
  • Martin-conde, Luisa, University Hospital Arnau de Vilanova, Lleida, Spain
  • Molina, Maria, Hospital Universitari Arnau de Vilanova, Lleida, Spain
  • Marco, María Paz, Hospital Universitari Arnau de Vilanova, Lleida, Spain
  • Segarra, Alfonso, Hospital Universitari Arnau de Vilanova, Lleida, Spain
Background

In idiopathic membranous nephropathy (iMN), the antibody titer of anti-PLA2R correlates with the activity of the disease and the likelihood of spontaneous remission (SR). Based on measurements of the basal anti-PLA2R titer, some authors have proposed algorithms, for guiding the decision making process regarding the timing for initiation of immunosuppresive treatment in patients with iMN.
Objectives: 1.- To analyze the probability of SR based on the initial titer of anti-PLA2R antibodies. 2.- Analyze if the dynamic of the antibody titer during the observation period, allows for a better estimation of the likelihood of SR.

Methods

94 patients with iMN with anti-PLA2R antibody titers> 20 U / mL at the time of diagnosis. The patients were followed for at least 6 months before initiation immunosuppressive therapy. Blood samples were obtained prospectively at the time of diagnosis, at 8 weeks, at 12, and at 24 weeks after diagnosis. The measurement of the anti-PLA2R titer, and the predictive capacity of these titers on the likelihood of SR was analyzed with ROC curves, univariate and multivariate analysis.

Results

28 of 94 patients (29.8%) entered immunological remission followed by clinical remission, which was total in 5 patients (5.31%) and partial in 23 (24.4%). The mean interval between diagnosis and immunological and clinical remission was 5.9 ± 1.6 months and 6.5 ± 2.3 months, respectively. Patients with SR presented lower proteinuria, lower anti-PLA2R titers at diagnosis, and a significant decrease thereof over time. The probability of SR was associated linearly with ranges of values, but not with a single value. The logistic model with greater predictive capacity included the basal titers and the change at 12 weeks.

Conclusion

In patients with iMN, the probability of SR can be estimated with adequate predictive power from the baseline anti-PLA2R antibodies, but a best estimation model is obtained when adding the antibody titer at 12 weeks.