Outcomes of primary membranous nephropathy based on serum anti-phospholipase A2 receptor antibodies and glomerular phospholipase A2 receptor antigen status: a retrospective cohort study

Yin, Peihong; Wang, Junxian; Liang, Wenyi; Zhan, Linda; Liu, Yuanhao; Lin, Jian; Chen, Xiaohong; He, Yingqin; Hongyun, Jian; Xie, Zhibin; Tan, Xiaofan; Ye, Qing; Huang, Fengxian

doi:10.1080/0886022x.2020.1792315

Cited by 12 publications

(12 citation statements)

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“…In line with other reports, we were unable to find significant differences in baseline clinical phenotype or outcome between anti-PLA2R antibody positive and negative patients in the original cohort [ 14 , 15 ]. In contrast, other studies reported that patients with anti-PLA2R antibodies negative MN had a better prognosis, with higher chances of achieving a clinical remission and a faster decline of proteinuria compared to patients with positive anti-PLA2R antibody [ 16 , 17 ]. However, these studies are limited by the relatively small number of patients with negative anti-PLA2R antibody included (10 and 13, respectively) [ 16 , 17 ].…”

Section: Discussionmentioning

confidence: 94%

“…In contrast, other studies reported that patients with anti-PLA2R antibodies negative MN had a better prognosis, with higher chances of achieving a clinical remission and a faster decline of proteinuria compared to patients with positive anti-PLA2R antibody [ 16 , 17 ]. However, these studies are limited by the relatively small number of patients with negative anti-PLA2R antibody included (10 and 13, respectively) [ 16 , 17 ].…”

Section: Discussionmentioning

confidence: 94%

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Negative anti-phospholipase A2 receptor antibody status at three months predicts remission in primary membranous nephropathy

et al. 2022

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Background The value of anti-phospholipase A2 receptor antibody (anti-PLA2R ab) monitoring at 3 months after diagnosis in membranous nephropathy (MN) remains uncertain. Methods We retrospectively examined the outcome on 1 August 2020 of 59 adult patients (age 54 (44, 68) years, 69% male, SCr 1.0 (0.9, 1.3) mg/dL) diagnosed with MN (kidney biopsy, positive serum anti-PLA2R ab). The outcomes were: kidney survival; partial and/or complete remission. Results Most of the studied patients (97%) received immunosuppression, cyclophosphamide regimens were the most frequent (87%), followed by cyclosporine (10%). The median time to remission was 12.0 months and the cumulative remission rates were 34% at 6, 54% at 12, and 73% at 24 months. Forty (69%) patients had negative anti-PLA2R ab at 3 months, they had similar age, serum creatinine, albumin, proteinuria, and treatment with the group with positive ab at 3 months. In the Cox proportional hazard model, three months anti-PLA2R ab negativization (HR 0.4 (95%CI 0.1, 0.9)) was an independent predictor for remission, while baseline hypoalbuminemia (HR 3.0 (95%CI 1.5, 5.7)) was associated with absence of remission. Six (10%) patients died, mostly due to cardiovascular disease and infections. A total of five (9%) patients started dialysis. Mean kidney survival time was 50.3 months and there was no survival difference in relation to baseline anti-PLA2R ab titer ( p .09) or 3 months negativization ( p .8). Conclusions Three months anti-PLA2R ab negativization seems to be a late predictor of remission, and lower serum albumin at diagnosis is an early marker for remission absence. Abbreviations: anti-P LA2R ab, anti-phospholipase A2 receptor antibody; eGFR, estimated glomerular filtration rate; ESKD, end stage kidney disease; MN, membranous nephropathy; NELL-1, neural epidermal growth factor-like 1 protein; RAAS: renin–angiotensin–aldosterone system; RBC: red blood cells; RRT, renal replacement therapy; T HSD7A, thrombospondin type-1 domain containing 7A

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 94%

Negative anti-phospholipase A2 receptor antibody status at three months predicts remission in primary membranous nephropathy

et al. 2022

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“…As an alternative to diseasespecific chronicity scores [5][6][7], the MCCS was proposed as a standardized pathology scoring system to address chronic changes in native kidney biopsies in a more uniform way, regard- less of the underlying diagnosis. The prognostic value of MCCS was validated in a large cohort of various native kidney diseases [3] and has shown to predict outcomes in individual cohorts of patients with C3 glomerulopathy (C3GP) [21,22], AAV [23], MN [24], FSGS [25] and MCD [26]. Due to its prognostic value, the MCCS was implemented in the FCGG registry from 2018 across all pathology centers.…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological characteristics and disease chronicity in native kidney biopsies in Flanders

Deleersnijder

Laurens

Meester

et al. 2022

Clinical Kidney Journal

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Background The Flemish Collaborative Glomerulonephritis Group (FCGG) registry provides complete population data on kidney disease epidemiology in the region of Flanders (Belgium), as it captures all native kidney biopsies performed in its population of 6.5 million inhabitants. Methods From 2017 until 2019, 2054 adult kidney biopsies were included from 26 nephrology centers (one biopsy per patient). Data on nephrotic and nephritic syndrome were available in 1992 and 2026 biopsies, respectively. In a subgroup of 898 biopsies containing ≥ 10 glomeruli from 2018–2019, disease chronicity was graded using the Mayo Clinic Chronicity Score (MCCS). The association between clinical variables and MCCS was determined using simple and multiple linear regression models. Results Nephrotic syndrome (present in 378 patients, 19.0%) was most frequently caused by minimal change disease in younger patients (18–44 years), membranous nephropathy in older patients (45–74 years) and amyloidosis in the elderly (> 75 years). Nephritic syndrome (present in 421 patients, 20.8%) was most frequently caused by IgA nephropathy (IgAN) in younger patients (18–64 years) and ANCA-associated vasculitis (AAV) in older patients (> 64 years). AAV and IgAN were the most frequent underlying diagnoses in biopsies in which crescents were identified. In multivariable analysis, acute and chronic kidney disease and diagnoses of diabetic kidney disease, nephrosclerosis and hyperoxaluria/hypercalcemic nephropathy were associated with highest MCCS increases. Conclusions The FCGG registry validates data from previous Western European registries and provides a snapshot of disease chronicity in the whole biopsied Flemish population.

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“…Furthermore, a decrease in the PLA2R antibody level predicts the remission of proteinuria. In addition, studies indicated that the PLA2R titer was associated with progressive loss of kidney function and a high risk for relapse [ 24 , 25 ]. According to the Kidney Disease: Improving Global Outcomes organization (KDIGO.org), the PLA2R antibody was listed as a high-risk factor resulting in the progression to end-stage kidney disease.…”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of Tripterygium wilfordii polyglycoside combined with angiotensin receptor blockers for the treatment of primary membranous nephropathy with sub-nephrotic proteinuria

Guo

Wang

et al. 2021

Renal Failure

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Outcomes of primary membranous nephropathy based on serum anti-phospholipase A2 receptor antibodies and glomerular phospholipase A2 receptor antigen status: a retrospective cohort study

Abstract: Huang (2020) Outcomes of primary membranous nephropathy based on serum anti-phospholipase A2 receptor antibodies and glomerular phospholipase A2 receptor antigen status: a retrospective

Cited by 12 publications

References 37 publications

Negative anti-phospholipase A2 receptor antibody status at three months predicts remission in primary membranous nephropathy

Negative anti-phospholipase A2 receptor antibody status at three months predicts remission in primary membranous nephropathy

Clinicopathological characteristics and disease chronicity in native kidney biopsies in Flanders

Retrospective analysis of Tripterygium wilfordii polyglycoside combined with angiotensin receptor blockers for the treatment of primary membranous nephropathy with sub-nephrotic proteinuria

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