Kidney Week

Abstract: SA-PO0836

Baseline Selectivity Index Predicts Risk of Relapse After Complete Remission in Patients with Primary Membranous Nephropathy

Session Information

• Glomerular Diseases: Management, Evolving Strategies, and Practice-Changing Advances
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Takahashi, Naoki, Fukui Daigaku, Fukui, Fukui Prefecture, Japan

Naoki Takahashi, MD, PhD

• Iwamura, Nanami, Fukui Daigaku, Fukui, Fukui Prefecture, Japan

Nanami Iwamura, MD, PhD

• Matsuta, Kohei, Fukui Daigaku, Fukui, Fukui Prefecture, Japan

Kohei Matsuta, MD

• Muramatsu, Chieko, Fukui Daigaku, Fukui, Fukui Prefecture, Japan

Chieko Muramatsu, MD

• Hosokawa, Akira, Fukui Daigaku, Fukui, Fukui Prefecture, Japan

Akira Hosokawa, MD

• Ito, Hiroaki, Fukui Daigaku, Fukui, Fukui Prefecture, Japan

Hiroaki Ito, MD

• Hamada, Hina, Fukui Daigaku, Fukui, Fukui Prefecture, Japan

Hina Hamada, MD

• Sakashita, Sayumi, Fukui Daigaku, Fukui, Fukui Prefecture, Japan

Sayumi Sakashita, MD

• Nishimori, Kazuhisa, Fukui Daigaku, Fukui, Fukui Prefecture, Japan

Kazuhisa Nishimori, MD

• Fukushima, Sachiko, Fukui Daigaku, Fukui, Fukui Prefecture, Japan

Sachiko Fukushima, MD

• Nishikawa, Yudai, Fukui Daigaku, Fukui, Fukui Prefecture, Japan

Yudai Nishikawa, MD

• Kobayashi, Mamiko, Fukui Daigaku, Fukui, Fukui Prefecture, Japan

Mamiko Kobayashi, MD

• Kasuno, Kenji, Fukui Daigaku, Fukui, Fukui Prefecture, Japan

Kenji Kasuno, MD, PhD

• Yoshida, Haruyoshi, Koritsu Obama Byoin Kumiai, Obama, Fukui Prefecture, Japan

Haruyoshi Yoshida, MD, PhD

• Iwano, Masayuki, Fukui Daigaku, Fukui, Fukui Prefecture, Japan

Masayuki Iwano, MD, PhD

• Toyama, Tadashi, Fukui Daigaku, Fukui, Fukui Prefecture, Japan

Tadashi Toyama, MD, PhD

Background

Relapse after complete remission in membranous nephropathy remains difficult to predict. The proteinuria selectivity index (SI) reflects glomerular barrier integrity, yet its prognostic value for relapse prediction has not been explored.

Methods

We conducted a retrospective cohort study of patients with biopsy-proven primary membranous nephropathy who had baseline SI measured at diagnosis. Time-to-event outcomes, including time to complete remission and relapse-free survival, were evaluated using Kaplan–Meier analysis and exploratory Cox regression.

Results

SI was significantly higher in phospholipase A2 receptor (PLA2R)-positive than in PLA2R-negative patients (median 0.279 vs 0.128, P=0.005). Among 12 patients who achieved complete remission, 6 subsequently relapsed. All 6 relapsers were PLA2R-positive, whereas 3 of 6 non-relapsers were PLA2R-positive. Baseline SI was significantly higher in relapsers than in non-relapsers (median 0.301 vs 0.104, P=0.026; Figure). In contrast, SI did not differ between patients who achieved complete remission and those who did not. In exploratory Cox regression, higher baseline SI tended to be associated with shorter relapse-free survival.

Conclusion

Baseline SI may serve as a clinically accessible marker for identifying patients at risk of relapse after complete remission in primary membranous nephropathy. The small sample size warrants cautious interpretation; if validated in larger cohorts, SI could inform post-remission monitoring strategies.

Baseline SI among patients evaluable for relapse analysis after complete remission. SI was significantly higher in patients who relapsed than in those who maintained remission (median 0.301 vs 0.104, P=0.026). Each dot represents an individual patient; horizontal bars indicate medians. Dashed line indicates SI = 0.2, conventional selectivity threshold.

Funding

• Government Support – Non-U.S.