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Abstract: SA-PO681

Prognostic Value of Anti-PLA2R-Ab on Long Term Outcomes in Primary Membranous Nephropathy

Session Information

Category: Glomerular Diseases

  • 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials

Authors

  • Ragy, Omar Sherin, Southmead Hospital, Bristol, Bristol, United Kingdom
  • Bate, Sebastian G., Manchester Metropolitan University, Manchester, United Kingdom
  • Bukhari, Samar Qaisera, The University of Sheffield, Sheffield, Sheffield, United Kingdom
  • Khwaja, Arif, The University of Sheffield, Sheffield, Sheffield, United Kingdom
  • Rao, Anirudh, NHS England and NHS Improvement North West, Manchester, Manchester, United Kingdom
  • Kanigicherla, Durga Anil K, Manchester Metropolitan University, Manchester, United Kingdom
Background

Better risk prediction tools are needed to improve longer-term outcomes in Primary Membranous Nephropathy (PMN). Studies well established the diagnostic utility of the Anti-PLA2R antibody test in PMN, but its prognostic value in clinical practice remains unclear. We aimed to assess a) the prognostic value of the Anti-PLA2R-Ab and compared its performance to conventional clinical markers of disease activity and b) the impact of testing on disease outcomes compared to outcomes before its discovery.

Methods

222 patients from three centres in the North of England, UK who were diagnosed with PMN from January 2003 to July 2019 and had a serum Anti-PLA2R-Ab test (contemporaneously or retrospectively) were included. Baseline markers including protein creatinine ratio (uPCR), estimated GFR (eGFR), Anti-PLA2R-Ab status (positive and negative), Ab titre (high and low), and time of test (contemporary and retrospective) were assessed for risk with outcomes. The primary outcome was time to progression (composite of doubling of serum creatinine, CKD5, and death). Secondary outcomes were time to partial remission (PR) and time to immunosuppression. Cox proportional hazard (PH) models adjusted for baseline conventional biomarkers were used.

Results

Cox PH tests did not show significant correlation between Anti-PLA2R-Ab status (positive vs negative) and both time to progression (aHR 0.93, p =0.71), and time to PR (aHR 0.84, p=0.13). A similar lack of association with time to progression was noted for the Ab titre, High vs Low (aHR 1.07, p=0.77); there was a trend for a longer time to PR in the high Ab titre group (aHR 0.794, p=0.08). There was a strong association between conventional clinical markers: eGFR (HRz 0.767, p<0.05) and uPCR (HRZ 1.44, p<0.005) and time to progression among all patients; and eGFR (HRz 0.61 p<0.005), among PLA2R-Ab positive patients. Time to Immunosuppression was significantly shorter in both the positive (HR=1.450, p<0.05) and high titre patients (aHR=1.42, p=0.02).

Conclusion

Anti-PLA2R-Ab status or Ab-titres do not outperform baseline conventional markers of eGFR and proteinuria in predicting disease progression in the longer term. Further studies are needed to best harness the utility of antibody testing in predicting disease progression in PMN.