The value of peripheral blood cell ratios in primary membranous nephropathy

Abstract

Background Primary membranous nephropathy (PMN) is a common cause of nephrotic syndrome in adults. Forty percent of the patients still continue to progress and worsen and eventually develop into chronic renal failure. Although phospholipase A2 receptor (PLA2R) is the major antigen of PMN in adults, the clinical features don’t often parallel with the antibody titers. Therefore, it is significant to find relative credible markers to predict the treatment response in patients with PMN. Methods In this study, 118 patients with PMN were recruited. The response to treatment was defined as ALB≥30g/L at 6 months and complete remission (CR) or not at the end of the follow-up visit. Renal outcome endpoint was defined as 50% or more Cr increase at the end. Results The patients with poor treatment effects had numerically higher platelet-lymphocytes ratio (PLR). Especially for patients with CR or not, the difference was near to statistic significant (P=0.095). It is noteworthy that when analyzing CR or not, the fitting of the binary logistic regression model including both PLA2R Ab titer and PLR (Hosmer-Lemeshow test: χ2=8.328, P=0.402; OR (PLA2R Ab titer) =1.002 (95% CI 1.000-1.004, P=0.042); OR (PLR) =1.006 (95% CI 0.999-1.013, P=0.098) was markedly better than that with only PLA2R Ab titer (Hosmer-Lemeshow test: χ2=13.885, P=0.016). The patients with renal function deterioration showed significantly higher monocyte-lymphocyte ratio (MLR) (0.26 (0.22-0.31) vs 0.18 (0.13-0.22), P=0.012). Conclusion PMN patients with poor treatment response tended to have higher PLR at the time of renal biopsy, and a higher MLR was associated with poor renal outcomes. Our findings suggested that PLR and MLR might be used to predict treatment efficacy and prognosis for PMN patients, respectively.