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Abstract: PO1478

Characteristics of Membranous Nephropathy Patients with IgG and IgA Co-Deposits on Capillary Wall

Session Information

Category: Glomerular Diseases

  • 1202 Glomerular Diseases: Immunology and Inflammation

Authors

  • Yi, Guan, Huashan Hospital Fudan University, Shanghai, Shanghai, China
  • Xie, Qionghong, Huashan Hospital Fudan University, Shanghai, Shanghai, China
  • Chen, Ruiying, Huashan Hospital Fudan University, Shanghai, Shanghai, China
  • Liu, Shaojun, Huashan Hospital Fudan University, Shanghai, Shanghai, China
  • Lai, Lingyun, Huashan Hospital Fudan University, Shanghai, Shanghai, China
Background

Membranous nephropathy (MN) is characterized by immune deposits on glomerular capillary wall, predominantly IgG. There have been several reports of MN combined with IgA nephropathy with features of IgA immunofluorescence staining in the glomerular mesangium. However, we found that IgA can also be deposited on the capillary wall with IgG. This study aimed to investigate the prognostic, clinical and renal histopathological characteristics of adult MN patients with IgG and IgA co-deposits on capillary wall.

Methods

A retrospective study was conducted in biopsy-proven MN patients of our renal department during January, 2007 to May, 2020. Clinical data were collected at time of biopsy and the latest followed-up. Pathological parameters included immunofluorescence staining, pla2r staining, membranous Churg’s stages, sclerosis, crescent, focal segmental sclerosis lesion, chronic tubulointerstitial injury and et al. Indirect immunofluorescence experiment was conducted in 293T cells transfected with pla2r plasmid.

Results

Out of 531 cases diagnosed with MN, 53 patients have moderate IgA deposit on capillary walls with IgG. 19 cases were determined to be secondary MN, which were 10 cases of autoimmune disease, 4 cases of Hepatitis B, 3 cases of kidney transplation, 1 case of chemical explosure and 1 case of AL amyloidosis-associated secondary MN. 31 Idiopathic MN patients with both IgA and IgG depositing along capillary wall were followed up for a median interval of 49months (interquartile-range,17-82) and 3 withdrew. 3 (9.8%) patients progressed to ESKD or death, 2 (6.5%) patients had their eGFR declined by half, 11 (35.5%) patients had no remission and 15 (53.6%) patients underwent immunosuppressive therapy. 72.4% idiopathic MN patients with IgA deposit were pla2r associated. Indirect immunofluorescence study revealed that both IgG and IgA isoform of anti-pla2r autoantibody in MN patients’ serum.

Conclusion

IgA and IgG could be co-depositing along glomerular capillary wall in MN patients, secondary causes should be screened with cation. IgA and IgG type of autoantibodies linked to MN co-existed in serum of idiopathic MN patients, whose prognosis might be poor.