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Abstract: PO1911

Utility of Immunofluorescent Intensity of IgG3 and Phospholipase A2 Receptor-to-IgG4 Ratio to Presume the Prognosis of Patients with Membranous Nephropathy

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Iwashita, Takatsugu, Department of Nephrology and Hypertension, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
  • Takayanagi, Kaori, Department of Nephrology and Hypertension, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
  • Yamasaki, Maiko, Department of Nephrology and Hypertension, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
  • Aoyagi, Mai, Department of Nephrology and Hypertension, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
  • Shimizu, Taisuke, Department of Nephrology and Hypertension, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
  • Hasegawa, Hajime, Department of Nephrology and Hypertension, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
Background

Membranous nephropathy (MN) is likely to show the long-term course and is a frequent glomerulonephritis in the elderly. For this reason, effective use of immunosuppressive drugs in a short period of time is desirable. In this study, we aimed to investigate the factors that could predict treatment responsiveness, using the treatment outcome in a short period of time, and retrospectively analyzed patients with MN in our hospital.

Methods

We included 66 patients who underwent renal biopsy and were diagnosed with MN in our hospital between April 2009 and December 2017. The percentage reduction in proteinuria one month after initiation of steroids, immunosuppressants, and ARBs was set to the endpoint. Intensity of immunofluorescent siaining (IF) was scored according to the criteria of Japanese Scoiety of Nephrology. Hematuria was quantified by 7-grade scoring of RBC numbers in high powered microscopic field.

Results

The intensity of IF (IgG subclass, PLA2R, THSD7A) was numerically evaluated and used for the analysis. The mean age of the patients included in the analysis was 66.4±11.7 years and baseline eGFR 63.9±18.7 ml/min, baseline urine protein was 7.05±5.45 g/gCr. Multiple parameters in high responder (HR, n=39) that resulted in less than 50% of urine protein after one month and low responder (LR, n=27) that remained proteinuria more than 50% were compared. Baseline urine protein and scored baseline hematuria were both higher in HR group (urine protein: 6.95 in HR vs 3.86 g/gCr in LR, p=0.003; hematuria: 1.0 in HR vs 0.0 in LR, p=0.036), but there was no difference in baseline eGFR (70.5 in HR vs 60.4 mL/min in LR, p=0.087). The mean dose of prednisolone was also not different between the two groups (18.6 in HR vs 14.0 mg/day in LR, p=0.451). In IF, significant differences were observed between the two groups in the scored staining intensity of IgG3 and the staining intensity ratio of PLA2R to IgG4 (PLA2R-to-IgG4 intensity ratio:PGIR) were both lower in HR group (IgG3: 0.0 in HR vs 0.5 in LR, p=0.049; PGIR: 0.58 in HR vs 1.00 in LR, p=0.029).

Conclusion

From the result of the present examination, staining intensity of IgG3 and intensity ratio of PLA2R to IgG4 might be helpful to predict better therapeutic responsiveness in addition to the baseline proteinuria and hematuria.