Abstract: FR-PO0805
Spontaneous Remission Is Rare in Patients with Phospholipase A2 Receptor (PLA2R)-Associated Membranous Nephropathy
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
- Russo, Ilario, Mayo Clinic Minnesota, Rochester, United States
- Vargas-Brochero, Maria J., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Cara, Anila, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Berti, Gian Marco, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Annese, Francesca, Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Bari Aldo Moro, Bari, Italy
- Gesualdo, Loreto, Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Bari Aldo Moro, Bari, Italy
- Sethi, Sanjeev, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Fervenza, Fernando C., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Zand, Ladan, Mayo Clinic Minnesota, Rochester, Minnesota, United States
Background
PLA2R-associated membranous nephropathy (MN) is a primary autoimmune glomerulopathy with a variable clinical course. While the historical "Rule of Thirds" suggests 30% spontaneous remission rate, these estimates preceded modern antigen-based diagnosis. The 2021 KDIGO guidelines recommends a conservative "wait-and-see" strategy in low-to-moderate risk patients with MN, but the real-world success of this approach specifically in PLA2R-positive cohorts remains poorly defined.
Methods
We assessed the rate of spontaneous complete (CR) and partial (PR) remissions in 239 PLA2R-associated MN patients retrospectively.
Results
Of 239 patients, 23 patients were managed conservatively with a wait-and-see strategy. Patients in this group presented with a significantly lower levels of proteinuria and serum creatinine. Over a median follow-up of 21.8 (13.3-56.5) months, 15 patients (6.2% of overall cohort) achieved remission after a median of 7.36 (4.7-29.6) months, and only 2 of those were CR (achieved after a mean of 10.6 (± 1.78) months) which is a rate of 0.8% (2/239) for the overall cohort. Among the patients who achieved spontaneous remission, 3/15 (20%) relapsed after a mean of 46.3 (± 81) months. Five of the 23 patients treated conservatively had available anti-PLA2R serology in follow up and 2 of these 5 patients achieved spontaneous immunological remission.
Conclusion
In PLA2R-associated MN, the rate of spontaneous remission is significantly lower than historical estimates for MN, with CR occurring in less than 1% of the total cohort. Our findings indicate that the conservative "wait-and-see" strategy is often insufficient to achieve complete remission and prevent relapses.