ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: FR-PO865

Anti PLA2R Antibody Titers and Disease Course in Primary Membranous Nephropathy

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • van den Brand, Jan A.J.G., Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
  • van de Logt, Anne-Els, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
  • Vink- van Setten, Coralien, Radboud UMC, Nijmegen, Netherlands
  • Wetzels, Jack F., Radboud University Medical Center, Nijmegen, Netherlands
Background

The natural course of primary membranous nephropathy (pMN) is highly variable. Up to half of the patients presenting with nephrotic syndrome will show progressive kidney function decrease. The remaining patients will show a spontaneous remission of proteinuria. Early prediction of prognosis is needed to personalize treatment.

Methods

We included 216 pMN patients referred to our hospital for urine analysis and followed these patients until renal progression, defined as an increase in serum creatinine of >50% from baseline, >25% to a level >1.5 mg/dl, or start of therapy due to severe nephrotic syndrome, or sponteaneous partial remission, defined as a reduction in proteinuria of >50% from baseline to a level <3.5 g/g creatinine with a stable serum creatinine. Anti-PLA2R antibody titers were determined using a EuroImmun ELISA assay. We created a multivariate prognostic model using cause-specific Cox regression that included baseline values for serum creatinine, urine protein creatinine ratio, anti-PLA2R antibody titer, α-1-microglobulin excretion rate.

Results

The table shows baseline characteristics for the study population. The prediction model showed good prognostic performance with a C-statistic of 0.78 (95%CI 0.71 to 0.84) for progression and 0.78 (0.70 to 0.85) for spontaneous remission at 24 months. The table shows baseline characteristics for the study population. The hazard ratio for progression was 1.07 (0.88 to 1.30) per doubling of aPLA2R titer. Conversely, the hazard ratio for partial remission was 0.68 (0.54 to 0.85). Discrimination was good with a C-statistic of 0.80 (95%CI 0.74 to 0.86) for progression and 0.76 (0.68 to 0.83) for spontaneous remission at 24 months. Predicted and observed risk of respectively progression and spontaneous remission were well calibrated.

Conclusion

Anti-PLA2R antibody titers appear to be predictive of spontaneous partial remission but not progression in primary MN.

Baseline characteristics
 Persistent NSProgressionPartial Remissionp
n113679 
Age (yrs)6153.6 (13.6)51.1 (14.9)NA
Females (%)038 (28)28 (35)0.41
Serum creatinine (µmol/l)10594.7 (19.5)84.7 (15.2)NA
Protein Creatinine Ratio (g / 10 mmol)3.958.7 [6.2, 11.4]5.9 [4.5, 8.1]<0.001
Α-1-microglobulin (ug/min)12.159.7 [34.5, 95.0]29.5 [19.4, 42.5]<0.001
Anti-PLA2R antibody titer829100 [33, 249]35 [1, 95]<0.001

Funding

  • Private Foundation Support