Abstract: PO1542
Use of Urinary Proteins as Predictors of Response to Immunosuppressive Treatment in Membranous Nephropathy
Session Information
- Glomerular Diseases: Clinical Features and Outcomes in Nephrotic Syndromes and Complement-Mediated Diseases
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1203 Glomerular Diseases: Clinical, Outcomes, and Trials
Authors
- Androga, Lagu A., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Viehman, Jason K., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Bobart, Shane A., Cleveland Clinic Florida, Weston, Florida, United States
- Vaughan, Lisa E., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Lieske, John C., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Zand, Ladan, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Greene, Eddie L., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Sethi, Sanjeev, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Cattran, Daniel C., Toronto General Hospital, Toronto, Ontario, Canada
- Fervenza, Fernando C., Mayo Clinic Minnesota, Rochester, Minnesota, United States
Background
Membranous nephropathy (MN) is the most common cause of nephrotic syndrome in adults. Prognosis is defined by remission in proteinuria. Response to immunosuppression agents such as calcineurin inhibitors and rituximab vary. While the presence of anti-PLA2R antibodies may help to guide prognosis and treatment strategies, further identifying biomarkers that could refine treatment decision would be useful. Using data from the MENTOR trial (NEJM 2019), we evaluated whether 24-hour total urinary protein, urinary albumin, immunoglobulin M (uIgM), immunoglobulin G (uIgG), and urinary alpha 1 microglobulin (uα1m) at baseline could be used to predict response to immunosuppressive therapy at 12 months in patients with MN.
Methods
Logistic regression models were used to study the relationship between baseline urinary proteins with patients’ treatment outcomes by treatment drug (rituximab or cyclosporine). The treatment outcome was defined as patients achieving either complete (CR; <0.3g/24 hours) or partial remission (PR; >0.3-<3.5g/24 hours) of proteinuria at 12 months.
Results
In both cyclosporine and rituximab arm, all urinary proteins exhibited a decline from baseline to 12 months post treatment. However, none of the baseline urinary proteins were found to be significantly associated with treatment response at 12 months (p>0.05 for all). Results were similar when restricted to patients with positive anti-PLA2R at baseline.
Conclusion
Baseline measures of the urinary albumin, uIgM, uIgG, and uα1m are not predictors of patients going into CR or PR at 12 months after treatment with rituximab or cyclosporine.
Table 1: Odds ratio of urinary protein predicting CR or PR at 12 months in patients treated with Rituximab or Cyclosporine (Fully Adjusted model)
| Urinary Protein | Treatment Group | All Patients | Anti-PLA2R Antibody Positive Patients | ||
| Odds Ratio (95% CI) | p-value | Odds Ratio (95% CI) | p-value | ||
| α1M, per 10 mg / 24hr | Rituximab | 1.018 (0.946, 1.096) | 0.631 | 1.024 (0.939, 1.117) | 0.591 |
| Cyclosporine | 1.009 (0.950, 1.072) | 0.767 | 1.006 (0.935, 1.082) | 0.873 | |
| Albumin, per 100 mg / 24hr | Rituximab | 0.996 (0.982, 1.011) | 0.596 | 0.995 (0.978, 1.013) | 0.577 |
| Cyclosporine | 0.992 (0.978, 1.006) | 0.270 | 0.990 (0.973, 1.007) | 0.257 | |
| IgM, per 10 µg / 24hr | Rituximab | 1.014 (0.984, 1.045) | 0.369 | 1.015 (0.983, 1.047) | 0.365 |
| Cyclosporine | 1.012 (0.988, 1.036) | 0.334 | 1.011 (0.986, 1.037) | 0.388 | |
| IgG, per 100 mg / 24hr | Rituximab | 0.988 (0.923, 1.057) | 0.718 | 0.972 (0.901, 1.050) | 0.472 |
| Cyclosporine | 0.958 (0.909, 1.009) | 0.101 | 0.941 (0.881, 1.004) | 0.067 | |
*Adjusted for adjust for age, sex, eGFR, and creatinine clearance