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Abstract: SA-PO680

PLA2R-Membranous Nephropathy in Black Americans: A Single Center Cohort

Session Information

Category: Glomerular Diseases

  • 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials

Authors

  • Kanduri, Swetha Rani, Ochsner Medical Center, New Orleans, Louisiana, United States
  • Varghese, Vipin, Ochsner Medical Center, New Orleans, Louisiana, United States
  • Velez, Juan Carlos Q., Ochsner Medical Center, New Orleans, Louisiana, United States

Group or Team Name

  • Ochsner Nephrology
Background

Phospholipase A2 receptor (PLA2R) antibody-associated membranous nephropathy (PLA2R-MN) is the most common type of MN. Although PLA2R-MN has been well characterized in cohorts in Asia, Europe and North America, description of its phenotype in a predominantly black population is lacking. We hypothesize that PLA2R-MN in black individuals is associated with unique serological or clinical phenotype.

Methods

We retrospectively reviewed records of adult patients diagnosed with PLA2R-MN in native kidneys over the last 5 years at a single medical center. Trajectories of anti-PLA2R titers were extracted. Rates of serological remission (SR) (anti-PLA2R < 2 RU/mL), partial remission (PR) [reduction in urine protein-to-creatinine ratio (UPCR) to 0.5 to 3.0 g/g without worsening serum creatinine (sCr)] and complete remission (CR) (UPCR < 0.5 g/g) were assessed at varying time points within a 24-month interval and compared between ethnic groups

Results

We included 41 patients, median age 61 years, 39% women, 61% self-identified black, 29% white, 5% Hispanic, and 5% Asian. PLA2R antigen was biopsy-verified in 30/41 (73%). Median peak anti-PLA2R titer was 269 (21 - >1500) vs 100 (24 – 850) RU/mL for black patients (n=25) and other races (n=16), respectively (p=0.01). Median sCr was 1.0 mg/dL for both groups (p=0.58), whereas the median UPCR were 5.8 g/g in black patients and 5.8 g/g in others (p=0.9). Patients receiving immunosuppression (IST) (cyclophosphamide, rituximab, tacrolimus-based regimens) included 14/25 (56%) black patients and 7/16 (44%) of other races. No patient on either race group achieved SR by 3 months. Although the overall SR rates after 24 months were comparable (52% vs 56%), SR was achieved at a later time for black patients compared to other races [5/13 (38%) vs 8/9 (88%) achieved SR by 12 months in black and non-black patients, respectively, p=0.022]. Comparable PR and CR rates were observed

Conclusion

Individuals of black race with PLA2R-MN present with higher peak anti-PLA2R titers and may take longer to achieve serological remission with IST. The temporal difference in achieving SR was not driven by less common use of IST. Prospective studies will be needed to expand on this observation and its potential implication on harder clinical endpoints