Kidney Res Clin Pract.  2018 Sep;37(3):248-256. 10.23876/j.krcp.2018.37.3.248.

Anti-phospholipase A2 receptor antibody as a prognostic marker in patients with primary membranous nephropathy

• Song EJ
• Jeong KH
• Yang YA
• Lim JH
• Jung HY
• Choi JY
• Cho JH
• Kim CD
• Kim YL
• Park SH

• KMID: 2447164
• DOI: http://doi.org/10.23876/j.krcp.2018.37.3.248

Abstract

BACKGROUND
Phospholipase A2 receptor (PLA2R) has been identified as a major autoantigen in primary membranous nephropathy (MN). We evaluated the association between anti-PLA2R antibodies and clinical outcome in Korean patients with primary MN.
METHODS
A total of 66 patients with biopsy-proven MN were included. Serum level of anti-PLA2R antibodies was measured by enzyme-linked immunosorbent assay. Biochemical parameters were estimated initially and at follow-up.
RESULTS
Anti-PLA2R antibodies were detected in 52.1% and 27.8% of patients with primary and secondary MN, respectively. Forty-eight patients with primary MN were grouped based on presence or absence of anti-PLA2R antibodies. Proteinuria was more severe in anti-PLA2R-positive patients than in anti-PLA2R-negative patients (urine protein/creatinine ratio 7.922 ± 3.985 g/g vs. 4.318 ± 3.304 g/g, P = 0.001), and anti-PLA2R antibody level was positively correlated with proteinuria. The incidence of chronic kidney disease stage ≥ 3 was higher in anti-PLA2R-positive patients compared with anti-PLA2R-negative patients (P = 0.004). The probabilities of spontaneous remission were higher in anti-PLA2R-negative patients compared with anti-PLA2R-positive patients (P < 0.001). Multivariate analysis demonstrated that anti-PLA2R antibodies are an independent risk factor for developing chronic kidney disease stage ≥ 3 and for not reaching spontaneous remission.
CONCLUSION
Detection of anti-PLA2R antibodies at diagnosis in patients with primary MN can predict prognosis and guide treatment decisions.

Keyword

Membranous nephropathy; Phospholipase A2 receptors; Prognosis

MeSH Terms

Antibodies
Diagnosis
Enzyme-Linked Immunosorbent Assay
Follow-Up Studies
Glomerulonephritis, Membranous*
Humans
Incidence
Multivariate Analysis
Prognosis
Proteinuria
Receptors, Phospholipase A2
Remission, Spontaneous
Renal Insufficiency, Chronic
Risk Factors
Antibodies
Receptors, Phospholipase A2