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KMID : 1102220180370030248
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Kidney Research and Clinical Practice
2018 Volume.37 No. 3 p.248 ~ p.256
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Anti-phospholipase A2 receptor antibody as a prognostic marker in patients with primary membranous nephropathy
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Song Eun-Joo
Jeong Kye-Hwa
Yang Young-Ae
Lim Jeong-Hoon
Jung Hee-Yeon
Choi Ji-Young
Kim Chan-Duck
Kim Yong-Lim
Park Sun-Hee
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Abstract
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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 rotein/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.
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KEYWORD
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Membranous nephropathy, Phospholipase A2 receptors, Prognosis
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