Relapse and its remission in Japanese patients with idiopathic membranous nephropathy

Kitajima, Shinji; Furuichi, Kengo; Sakai, Norihiko; Sagara, Akihiro; Shinozaki, Yukiko; Toyama, Tadashi; Iwata, Yasunori; Shimizu, Miho; Yokoyama, Hitoshi; Kaneko, Shuichi; Wada, Takashi

doi:10.1007/s10157-014-0987-9

Cited by 7 publications

(4 citation statements)

References 14 publications

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“…Initial clinicopathological findings such as the degree of proteinuria, decreased renal function or heterogenous finding on electron microscopy at the time of initial biopsy have been considered as prognostic factors in MN [33,34] . But there has been no proven factor that can be utilized to predict the prognosis for patients in relation to clinical and pathologic findings.…”

Section: Discussionmentioning

confidence: 99%

Anti-Phospholipase A2 Receptor Antibody as Prognostic Indicator in Idiopathic Membranous Nephropathy

et al. 2015

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Background: Anti-phospholipase A2 receptor antibody (PLA2R-Ab) is useful in diagnosing idiopathic membranous nephropathy (IMN). We investigated the clinical relevance of PLA2R-Ab enzyme-linked immunosorbent assay (ELISA) in patients with IMN. Methods: We measured PLA2R-Ab with an ELISA kit from the serum of 160 patients with IMN (n = 93), secondary MN (n = 14) and other glomerulonephritis (n = 41) as well as healthy controls (n = 12) at the time of renal biopsy and investigated the correlation of titers of PLA2R-Ab with clinical parameters. Results: PLA2R-Ab was positive in 41 of 93 patients (44.1%) with IMN. No samples from the patients with secondary MN and other glomerulonephritis or healthy controls were positive with the ELISA test. The PLA2R-Ab-positive patients showed severe disease activity and a low remission rate. The PLA2R-Ab titer positively correlated with proteinuria and was negatively associated with renal function and serum albumin. The patients with a high titer of PLA2R-Ab had significantly decreased remission rates. The cumulative probabilities of remission was significantly lower in patients with PLA2R-Ab (p = 0.01) and even so in patients with a high titer of PLA2R-Ab (p = 0.04). When we compared the ELISA titers with Western blot (WB) data of 43 patients who had been enrolled in our previous study, 18 and 30 patients were positive on ELISA (41.9%) and WB (69.8%), respectively. WB and ELISA had a concordance rate of 72.1% and were positively correlated (r = 0.590, p < 0.001). Conclusion: The presence, as well as a high titer, of PLA2R-Ab on ELISA was associated with poor prognosis of IMN. Assessment of PLA2R-Ab with ELISA is an easy and reliable tool for the diagnosis and guidance of therapeutic plans.

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Section: Discussionmentioning

confidence: 99%

Anti-Phospholipase A2 Receptor Antibody as Prognostic Indicator in Idiopathic Membranous Nephropathy

et al. 2015

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“…Overall, 40 % of Japanese patients with nephrotic syndrome and 33–50 % of patients with nephrotic syndrome in other countries either develop end-stage renal disease within 20 years of onset. Mortality from MN is high due to complications, such as infection, cardiovascular events, or malignancy [ 1 – 6 ]. The pathogenesis of iMN was not understood until the landmark study by Beck et al in 2009, which demonstrated that the major target antigen of autoantibodies in iMN is an M-type phospholipase A2 receptor (PLA2R) expressed on podocytes [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of anti-phospholipase A2 receptor antibodies in Japanese patients with membranous nephropathy

Akiyama

Imai

et al. 2014

Clin Exp Nephrol

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BackgroundMembranous nephropathy (MN) is the leading cause of nephrotic syndrome in adults. Anti-M-type phospholipase A2 receptor (anti-PLA2R) antibodies are found in most patients with idiopathic MN (iMN) worldwide, but the prevalence of anti-PLA2R antibodies among Japanese patients with MN is unknown. In this study, we determined the prevalence of anti-PLA2R antibodies in Japanese patients with MN.MethodsThe study population of our retrospective cross-sectional consisted of 131 patients with biopsy-proven MN who had not received any immunosuppressive treatments at time of both renal biopsy and serum sample collection. Of these, 100 had iMN and 31 had secondary MN (sMN). The circulating anti-PLA2R antibodies were analyzed using a highly sensitive Western blot analysis. Analysis was performed under non-reducing conditions with a human glomerular extract at serum dilutions of 1:25, 1:10, and 1 as the primary antibody.ResultsAnti-PLA2R antibodies were detected in 53 (53 %) of 100 patients with iMN and 0 (0 %) of 31 patients with sMN. The prevalence of anti-PLA2R antibodies was higher in patients with nephrotic syndrome (61 %) than in patients without nephrotic syndrome (43 %). The number of patients with serum albumin ≤3.0 g/dL was significantly higher in those with anti-PLA2R antibodies (92 %) than that in those without them (68 %).ConclusionsAnti-PLA2R antibodies were found in Japanese patients with iMN; however, the prevalence was lower than that of any other Asian country. This may indicate that the presence of other pathogenic antigens plays a significant role in Japanese patients with iMN.

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“…Other retrospective studies have been undertaken in China [ 18 ], Korea [ 19 ], Japan [ 20 , 21 ], Australia and New Zealand [ 22 ], USA [ 23 ] and the UK [ 24 ]. In an elderly cohort from Korea [ 19 ], immunosuppression use was found to increase the likelihood of adverse renal outcomes and increased rates of infection, whereas RAS blockade reduced both, suggesting that use of immunosuppression should be carefully considered in the elderly.…”

Section: Discussionmentioning

confidence: 99%

A low rate of end-stage kidney disease in membranous nephropathy: A single centre study over 2 decades

Storrar

Gill-Taylor²,

Chinnadurai³

et al. 2022

PLoS ONE

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Introduction Membranous nephropathy is the commonest cause of nephrotic syndrome in non-diabetic Caucasian adults over the age of 40 years. Primary membranous nephropathy is limited to the kidneys. Clinical management aims to induce remission, either spontaneously with supportive care, or with immunosuppression. Here, we describe the natural history of this condition in a large tertiary centre in the UK. Methods 178 patients with primary membranous nephropathy were identified over 2 decades. We collected data on demographics, baseline laboratory values, treatment received and outcomes including progression to renal replacement therapy and death. Analysis was performed on the whole cohort and specific subgroups. Univariate and multivariate Cox regression was also performed. Results Median age was 58.3 years with 63.5% male. Median baseline creatinine was 90μmol/L and urine protein-creatinine ratio 664g/mol. Remission (partial or complete) was achieved in 134 (75.3%), either spontaneous in 60 (33.7%) or after treatment with immunosuppression in 74 (41.6%), and of these 57 (42.5%) relapsed. Progression to renal replacement therapy was seen in 10.1% (much lower than classically reported) with mortality in 29.8%. Amongst the whole cohort, those who went into remission had improved outcomes compared to those who did not go into remission (less progression to renal replacement therapy [4.5% vs 28%] and death [20.1% vs 67%]. Those classified as high-risk (based on parameters including eGFR, proteinuria, serum albumin, PLA2R antibody level, rate of renal function decline) also had worse outcomes than those at low-risk (mortality seen in 52.6% vs 10.8%, p<0.001). The median follow-up period was 59.5 months. Conclusion We provide a comprehensive epidemiologic analysis of primary membranous nephropathy at a large tertiary UK centre. Only 10.1% progressed to renal replacement therapy. For novelty, the KDIGO risk classification was linked to outcomes, highlighting the utility of this classification system for identifying patients most likely to progress.

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Relapse and its remission in Japanese patients with idiopathic membranous nephropathy

Abstract: Our results suggest that patients with relapse achieved CR or ICR I and that electron microscopic findings demonstrating heterogeneous type indicated susceptibility to relapse.

Cited by 7 publications

References 14 publications

Anti-Phospholipase A2 Receptor Antibody as Prognostic Indicator in Idiopathic Membranous Nephropathy

Anti-Phospholipase A2 Receptor Antibody as Prognostic Indicator in Idiopathic Membranous Nephropathy

Prevalence of anti-phospholipase A2 receptor antibodies in Japanese patients with membranous nephropathy

A low rate of end-stage kidney disease in membranous nephropathy: A single centre study over 2 decades

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