ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

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

Authors

  • 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
Background

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.

Methods

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.

Results

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).

Conclusion

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
P-value*
N202020 
Age (yrs)
Gender M/F
62 ± 13
17 / 3
60±12
13 / 7
62±13
14 / 6
NS
NS
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]
NS
NS
0.022
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

Funding

  • Commercial Support