The prognostic value of phospholipase A2 receptor autoantibodies on spontaneous remission for patients with idiopathic membranous nephropathy

Abstract

Background:The presence of antibodies against phospholipase A2 receptor (PLA2R-Abs) in serum at diagnosis is reported to be related to the rate of spontaneous remission in patients with idiopathic membranous nephropathy (IMN); however, there is still lack of enough samples to illustrate this problem. Here, we conducted a comprehensive meta-analysis to investigate the prognostic value of PLA2R-Abs on spontaneous remission for IMN patients in the absence of immunosuppressive therapy.Methods:A systematic search of the PubMed, EMBASE, and Cochrane Central databases was performed for relevant original articles published until October 2017. All studies focus on spontaneous remission rates in IMN patients associated with PLA2R-Abs, the endpoint of interest is spontaneous remission rate. Risk ratio (RR) and corresponding 95% confidence intervals (CI) were carried out using a fixed or random effects model. The data were analyzed by Review Manager 5.3 software.Results:A total of 5 articles involving 190 patients were included in this meta-analysis. There were significant differences between the 2 groups in spontaneous remission rate. The seropositive of PLA2R-Abs measured at the time of diagnosis was negatively correlated with the likelihood of spontaneous remission (RR = 0.69; 95% CI, 0.56–0.87; P = .001).Conclusion:In PLA2R-Abs seronegative patients, the spontaneous remission rate is higher than that of PLA2R-Abs seropositive patients during symptomatic treatment. Therefore, in order to avoid malignant events caused by immunosuppressive therapy, maybe it is more beneficial to adopt conservative treatment for PLA2R-Abs seronegative patients at initial treatment.

Anti-phospholipase A2 receptor antibody and spontaneous remission in membranous nephropathy

“…Interestingly, their study reinforces the important role of anti-PLA2R in the clinical prediction of the IMN course at the diagnosis and suggests that patients with high anti-PLA2R levels (>40 UI/mL) and high proteinuria (>4 g/day) could benefit from immunosuppressive treatment, whereas patients with low anti-PLA2R levels (<40 UI/mL) and low proteinuria (<4 g/day) could benefit from a longer period of follow-up with conservative treatment [7] (see suggested treatment algorithm, Figure 1). In concordance with their results, other studies and a recent meta-analysis also demonstrated that IMN patients with anti-PLA2R at renal biopsy presented high spontaneous remission rate with conservative treatment [8, 9]. In the current study, Rodas and colleagues [7] took a step forward and demonstrated that the levels of anti-PLA2R are clearly related to the IMN prognostic and subsequently may help to detect patients at risk for CKD progression.…”

Receptor autoimmunity: diagnostic and therapeutic implications

“…IgG4 anti-PLAR antibodies are present in 50-80% of subjects with IMN [50,51] and virtually absent in secondary forms of IMN and other glomerular diseases [52]. Recently several new commercial immunoassays have been introduced with different assay formats; currently, CBA-IFI, ELISA and MBA-FIA methods are available in clinical practice and the serology quantitative approach is the cornerstone of the diagnosis, differential diagnosis, prognostic evaluation of activity, prediction of remission, and monitoring of post-transplant recurrence of the disease [53][54][55][56][57].…”

“…If for GD the debate on the threshold values of TRAb as predictors of remission/relapse remains open, the importance of ascertaining seronegative patients after withdrawal of therapy is not in question, because they have a better prognosis than those who are seronegative at various levels of concentration [29]. This last statement is certainly also demonstrated for PLA2RAb in IMN [55,56], but not yet for MG or NMDAR encephalitis.…”

Serum anti-phospholipase A2 receptor (PLA2R) antibody detected at diagnosis as a predictor for clinical remission in patients with primary membranous nephropathy: a meta-analysis

“…In addition, the impact of sPLA2R-ab on clinical remission in PMN patients remains unclear. Currently, only one meta-analysis [11] has identified the impact of sPLA2R-ab on spontaneous remission in patients with PMN; however, it’s not exhaustive nor complete. To further address this issue, we performed a comprehensive meta-analysis to derive a more precise estimate of the prognostic value of the sPLA2R-ab among patients with PMN.…”