Kidney Week

Abstract: FR-PO0804

Antigen-Specific Differences in Membranous Nephropathy: Lower Response and Higher Relapse Rates in Phospholipase A2 Receptor (PLA2R)-Associated Disease

Session Information

• Glomerular Diseases: Practice and New Concepts Shaping Modern Care
  October 23, 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

• Santos, Julio Cesar, Universidad Autonoma del Estado de Hidalgo, Pachuca, Hgo., Mexico

Julio Cesar Santos, MD

• Garcia, Héctor Benjamín, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico

Héctor Benjamín Garcia, MD

• Quiñonez-Flores, Alejandro, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico

Alejandro Quiñonez-Flores, MD

• Matías Martinez, Melvin Barish, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico

Melvin Barish Matías Martinez, MD

• Mendez, Andre, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico

Andre Mendez, MD

• Reyes-Moreno, Juan-Esteban, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico

Juan-Esteban Reyes-Moreno

• Uribe-Uribe, Norma O., Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico

Norma O. Uribe-Uribe, MD

• Mejia-Vilet, Juan M., Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico

Juan M. Mejia-Vilet, MD, PhD

• Zavala Miranda, María Fernanda, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico

María Fernanda Zavala Miranda

Background

Antigen-specific prognosis in membranous nephropathy (MN) remains under evaluation. We assessed outcomes in MN stratified by antigen status in the kidney biopsy.

Methods

Retrospective cohort of MN. Kidney biopsy tissue from all available patients diagnosed with MN between 2004 and 2023 underwent immunohistochemistry for PLA2R and NELL1. Patients were classified as PLA2R(+), NELL1(+), or PLA2R/NELL1(-). Clinical, histological, and treatment variables were collected. Outcomes were complete response, disease relapses, kidney failure, and mortality. All outcomes were analyzed by survival analyses (time-to event).

Results

Among 120 patients, 58 (48%) PLA2R(+), 15 (13%) NELL1(+), and 47 (39%) PLA2R/NELL1(-). Median age was 42 years (IQR 33-51), 68 (57%) male, with a median follow-up of 97 months (IQR 50-133). PLA2R(+) patients had higher baseline proteinuria (7.6 vs 5.5 vs 5.5 g/24h) and greater chronicity on biopsy. In adjusted analyses, PLA2R(+) status was associated with lower complete response vs NELL1(+) (aHR 0.37, 95%CI 0.14-0.94) and higher relapse than double-negative (aHR 4.75, 95%CI 1.85-12.2) [Figure 1]. Rituximab as initial therapy was associated with higher complete response (aHR 2.48, 95%CI 1.16-5.30) and lower relapse (aHR 0.17, 95%CI 0.03-0.98).

Conclusion

PLA2R-associated MN is linked to lower complete response and higher relapse risk than other antigen specificities. Nearly 40% of patients lacked identifiable PLA2R or NELL1, highlighting the need for further antigen evaluation in this cohort.

Acknowledgment

None.

Figure 1. Time to renal response (A) and time to renal relapse (B) by antigen specificity.