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Kidney Week

Abstract: PO1651

Prospective Cohort Study of Antibody-Guided Therapy in Patients with Membranous Nephropathy

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • van de Logt, Anne-Els, Radboud Universiteit, Nijmegen, Gelderland, Netherlands
  • Vink- van Setten, Coralien, Radboud Universiteit, Nijmegen, Gelderland, Netherlands
  • Wetzels, Jack F., Radboud Universiteit, Nijmegen, Gelderland, Netherlands
Background

Guidelines advise a standard course of 6 months of cyclophosphamide (CP) and steroids in patients with membranous nephropathy (MN). We hypothesized that monitoring of aPLA2R- antibodies (aPLA2R) may enable individualized (and shorter duration of) therapy.

Methods

Patients with MN, with positive aPLA2R and high risk of progression were included. Treatment consisted of CP (1.5 mg/kg/day combined with steroids). aPLA2R were monitored (IFT test) at 8, 16, and 24 weeks after start of treatment. If the IFT test was negative, CP was stopped and prednisone tapered. If the IFT test remained positive at 24 weeks, CP was switched to MMF and therapy continued.

Results

Sixty-five patients (48 males) were included; mean age 61 ± 12 yrs, median serum creatinine 136 [IQR 100-161] µmol/l, serum albumin 21 [IQR 16-26] g/l and UPCR 7.7 [IQR 5.4-11.1] g/10 mmol. Follow-up was 37 [IQR 27-58] months. aPLA2R test was negative in 46 patients after 8 weeks (group A), in 10 patients after 16 weeks (group B1), in 1 patient after 24 weeks (group B2) and in 8 patients aPLA2R remained positive after more than 24 weeks (group B3). In group A no clinical remission (PCR >3.0 g/10 mmol) was observed in 26 % (12 patients) compared to 21 % (4 patients) in group B1-B3 (Log rank p=0.579). Overall 22 patients (34 %) received additional immunosuppressive (IS) therapy because of persistent proteinuria (after aPLA2R disappearance) or clinical relapse. IS free survival was lower in group A compared to group B1-B3. (Figure 1).

Conclusion

Approximately 50% of patients developed long-term clinical remission after 8 weeks of therapy. Our data support aPLA2R-guided therapy. However, in approximately 25% of patients immunological remission was not followed by clinical remission, underlining the need for better biomarkers.

Relapse or start of second immunosuppressive therapy

Funding

  • Other NIH Support