Abstract: FR-PO865
Anti PLA2R Antibody Titers and Disease Course in Primary Membranous Nephropathy
Session Information
- Glomerular Diseases: Membranous Nephropathy, SLE, Complement
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
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 NS | Progression | Partial Remission | p | |
| n | 1 | 136 | 79 | |
| Age (yrs) | 61 | 53.6 (13.6) | 51.1 (14.9) | NA |
| Females (%) | 0 | 38 (28) | 28 (35) | 0.41 |
| Serum creatinine (µmol/l) | 105 | 94.7 (19.5) | 84.7 (15.2) | NA |
| Protein Creatinine Ratio (g / 10 mmol) | 3.95 | 8.7 [6.2, 11.4] | 5.9 [4.5, 8.1] | <0.001 |
| Α-1-microglobulin (ug/min) | 12.1 | 59.7 [34.5, 95.0] | 29.5 [19.4, 42.5] | <0.001 |
| Anti-PLA2R antibody titer | 829 | 100 [33, 249] | 35 [1, 95] | <0.001 |
Funding
- Private Foundation Support