Rationale & Objective In antiPLA2R membranous nephropathy (MN), there is controversy whether spontaneous remission (SR) can be predicted using a single titer, or assessing the dynamic changes anti-PLA2Rab titers. The study objective was to identify the optimal dynamics of anti-PLA2Rab titer to predict SR in MN Patients and Method 127 nephrotic patients with antiPLA2R-MN were prospectively followed-up for 6 months under conservative treatment. Anti-PLA2Rab and proteinuria were assessed at diagnosis and monthly thereafter. The primary end-point (PEP) was the reduction of proteinuria ≥50% at 6 months. Logistic models with baseline and evolutive antiPLA2Rab titers were developed to predict the PEP. Results 28 patients (22%) reached the PEP. These patients were more frequently female and had significantly lower baseline proteinuria and anti-PLA2Rab titers. An anti-PLA2R titer ≤ 97.5 RU/mL at diagnosis, had a sensitivity of 71% and a specificity of 81% to predict the PEP. The model including baseline anti-PLA2Rab and a reduction ≥ 15% at 3 months predicted the PEP with a sensitivity of 93% and a specificity of 80%, with an AUC significantly higher than that obtained with relative changes of proteinuria at the same period of time [0.95 (95%CI: 0.91-0.98) vs 0.79 (95%CI: 0.70-0.88) respectively p: 0.0013]. Conclusions combining the baseline antiPLA2Rab titers with their relative changes at 3 months after diagnosis, gives the earliest prediction for achieving a reduction of urinary protein excretion ≥50% at 6 months in MN, thereby shortening the observation period currently recommended to make individualized decisions to start immunosuppressive therapy.
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