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Kidney Week

Abstract: PO1650

An 8-Week Course of Cyclophosphamide and Steroids Is Effective Therapy in Patients with Membranous Nephropathy (MN) and Low PLA2Rab Levels

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials


  • Vink- van Setten, Coralien, Radboudumc, Nijmegen, Gelderland, Netherlands
  • van de Logt, Anne-Els, Radboudumc, Nijmegen, Gelderland, Netherlands
  • Kühnl, Alexander, EUROIMMUN Medizinische Labordiagnostika AG, Lubeck, Schleswig-Holstein, Germany
  • Wetzels, Jack F., Radboudumc, Nijmegen, Gelderland, Netherlands

We introduced individualized therapy in patients with MN and positive anti PLA2R antibodies (aPLA2R) by IIFT test. Treatment (cyclophosphamide combined with steroids) was stopped when the IIFT test (measured at 8, 16, or 24 weeks) became negative. After 8 weeks, 71% of patients were in immunological remission. Unfortunately, 30% of these latter patients needed renewed therapy within 12 months because of immunological and/or clinical relapse. We questioned if quantitative aPLA2R measurement would predict response.


Available, stored serum samples were retrieved, and aPLA2R levels were measured by ELISA (EUROIMMUN Lübeck, Germany). Good outcome was defined as immunological remission at 8 weeks, followed by clinical remission without clinical relapse nor the need for additional immunosuppressive therapy within 12 months.


Serum samples of 60 patients were available for analysis. Patients were grouped according tertiles of aPLA2R (Table). Higher aPLA2R levels were associated with more severe proteinuria. Patients in the lowest tertile were more likely to develop immunological remission at 8 weeks (95% vs 65% and 50% in the middle and highest tertiles). Moreover, in the subgroup of patients who were treated for 8 weeks only, fewer patients in the lowest tertile of aPLA2R needed renewed immunosuppressive therapy, although not statistically significant (16% vs 43%, p 0.054).


Individualized treatment of MN patients with cyclophosphamide and steroids has been recently introduced. In this study we show that baseline aPLA2R levels predict immunological remission at 8 weeks. Furthermore, patients with low aPLA2R levels at baseline seem to be more likely to have a good overall outcome.

Baseline clinical characteristics and immunological remission at week 8
 Lowest tertile
<98 RU/ml
Middle tertile
98-210 RU/ml
Highest tertile
>210 RU/ml
Age (yrs)
Gender M/F
62 ± 13
17 / 3
13 / 7
14 / 6
S creatinin (umol/L)
S albumin (g/L)
UPCR (g/10mmol)
148 [113-160]
21 [18-28]
6.7 [4.2-8.1]
119 [95-170]
21 [16-26]
9.3 [5.9-13.6]
142 [103-166]
18 [14-26]
9.4 [6-13.1]
aPLA2Rab negative at 8 weeks (N (%))19 (95)13 (65)10 (50)0.005

Data shown as mean±SD or median[IQR]. *By kruskall-wallis test of Fishers' exact test, as applicable


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