Retrospective study: clinicopathological features and prognosis of idiopathic membranous nephropathy with seronegative anti-phospholipase A2 receptor antibody

Abstract

Background To discuss the clinicopathological features and prognosis of patients with idiopathic membranous nephropathy (IMN) who are serum-negative for the anti-PLA2R antibody. Method Overall, 229 IMN patients were retrospectively collected in this study and classified into anti-PLA2R antibody-negative (PLA2R−, 59 cases) and antibody-positive (PLA2R+, 170 cases) groups. The clinical and pathological features of the PLA2R− group were analyzed; 162 patients in both groups were followed up, and the PLA2R antigen was detected in renal biopsies from the PLA2R− group. Kaplan-Meier and survival analyses were used to compare differences in prognosis. Results Serum albumin levels were higher and 24-hour urine protein, creatinine, and beta 2-microglobulin (BMG) levels were lower in the PLA2R− group than in the PLA2R+ group; the proportion of acute and chronic tubular lesions was also significantly lower in the PLA2R− group than in in the PLA2R+ group. After treatment, the remission rate was significantly higher in the negative group than in the positive group (93.02% vs 74.78%,), especially the rate of complete remission (51.16% vs 23.47%). Furthermore, the PLA2R antigen-positive staining rate of 43 patients in the PLA2R− group was 62.79%. Although not significant, the survival rate was higher in the PLA2R− group than in the PLA2R+ group. BMG, 24-hour urine protein and acute and chronic tubular lesions were risk factors for kidney death, and 24-hour urine protein was an independent risk factor for kidney death. Conclusions Compared with the PLA2R+ group, the PLA2R− group had mild clinical manifestations and pathological damage and a higher clinical treatment remission rate. Renal tissue PLA2R antigen testing can be considered for patients with seronegative IMN to increase the diagnostic rate.

Efficacy and Safety of Different Immunosuppressive Therapies in Patients With Membranous Nephropathy and High PLA2R Antibody Titer

“…Serum albumin and urinary protein are generally used to quantitatively evaluate the severity of nephrotic syndrome in MN, which are important indicators for assessing disease activity ( Kanigicherla et al, 2013 ; Lin et al, 2015 ; Gopalakrishnan et al, 2016 ; Li et al, 2016 ). Consistent with data from aforementioned studies ( Li et al, 2016 ; Song et al, 2018 ; Provatopoulou et al, 2019 ; Katsumata et al, 2020 ; Li et al, 2021 ), we found a significant association of PLA2Rab with urinary protein and serum albumin indicating the correlation between antibody levels and disease activity ( Mahmud et al, 2019 ; Gong et al, 2020 ; Guo et al, 2020 ). However, Jullien et al (2017 ) claimed that the initial PLA2Rab level did not relate to the degree of proteinuria.…”

Curcumin Improves the Renal Autophagy in Rat Experimental Membranous Nephropathy via Regulating the PI3K/AKT/mTOR and Nrf2/HO-1 Signaling Pathways

“…Membranous nephropathy (MN), an autoimmune disease, is one of the frequent causes of end-stage renal disease in adults. A recent retrospective study has suggested that the incidence of IMN is increasing, especially in the younger ones [ 33 ]. Its therapeutic regimen also is unsatisfactory and controversial due to the heterogeneity of the disease, although approximately a third of patients will achieve spontaneous remission [ 34 ].…”

Clinical Study of THSD7A, SOD2 and AR Antigens in Idiopathic Membranous Nephropathy

“…Furthermore, the level of antibody is closely related to disease activity. Our study of patients negatives for the anti-PLA2R antibody demonstrated that combined kidney tissue PLA2R and IgG4 staining can effectively improve the accuracy of disease diagnosis 5 .…”