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. 2020 Mar;25(3):219-229.
doi: 10.1111/nep.13691. Epub 2020 Jan 20.

Clinical value of renal phospholipase A2 receptor deposit in the prognosis evaluation and treatment options of idiopathic membranous nephropathy: A retrospective cohort study

Zhiyong Xie  1   2 , Wei Dong  1 , Zhilian Li  1 , Yuanhan Chen  1 , Li Song  1 , Ruizhao Li  1 , Yanhua Wu  1 , Lei Fu  1 , Huaban Liang  1 , Yiming Tao  1 , Jianteng Xie  1 , Wenjian Wang  1 , Shuangxin Liu  1 , Zhiming Ye  1 , Wei Shi  1 , Xinling Liang  1
Affiliations

Clinical value of renal phospholipase A2 receptor deposit in the prognosis evaluation and treatment options of idiopathic membranous nephropathy: A retrospective cohort study

Zhiyong Xie et al. Nephrology (Carlton). 2020 Mar.

Abstract

Aim: Phospholipase A2 receptor (PLA2R) is a target antigen for idiopathic membranous nephropathy (IMN). However, the association between renal PLA2R antigen and disease prognosis had not been fully investigated. In addition, there was a paucity of studies investigating the difference of therapeutic effects between cyclophosphamide and cyclosporine A in PLA2R-associated IMN.

Methods: This retrospective cohort study recruited 300 eligible patients diagnosed with biopsy-proven IMN between September 2015 and July 2018 in Guangdong Provincial People's Hospital. The remission of proteinuria was compared between PLA2R-associated and non-PLA2R-associated IMN. The difference of therapeutic effects between cyclophosphamide and cyclosporine A were also investigated in PLA2R-associated IMN.

Results: The positive rate of renal PLA2R antigen in recruited IMN patients was 82.3%. Non-PLA2R-associated IMN patients had a higher probability to achieve remission than PLA2R-associated IMN patients (Log-rank test, P = .013). Multivariate COX analysis showed that renal PLA2R antigen was an independent risk factor for not achieving remission in IMN patients (Hazard Ratio: 1.619; 95% confidence interval: 1.133 to 2.313; P = .008). In PLA2R-associated IMN, patients receiving cyclophosphamide had a higher probability to achieve remission compared with those receiving cyclosporine A (Log-rank test, P = .018) while there was no difference in renal survival. Multivariate COX regression analysis showed that compared with cyclosporine A, patients receiving cyclophosphamide had a higher probability to achieve remission.

Conclusion: Phospholipase A2 receptor -associated IMN patients had a lower probability to achieve remission compared with non-PLA2R-associated IMN. Compared with cyclosporine A, cyclophosphamide exerted better therapeutic effects in remission of proteinuria and may be the preferred immunosuppressant for PLA2R-associated IMN. SUMMARY AT A GLANCE This article highlighted the prognostic value of intra-renal phospholipase A2 receptor deposition in idiopathic membranous nephropathy (IMN). Renal phospholipase A2 receptor (PLA2R)-associated IMN patients had a lower probability to achieve remission compared with non-PLA2R-associated IMN.

Keywords: idiopathic membranous nephropathy; phospholipase A2 receptor; prognosis evaluation; treatment options.

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Conflict of interest statement

The authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1
Flow chart of the patients enrolled in the study
Figure 2
Figure 2
Kaplan‐Meier analysis of the remission of proteinuria in patients with positive and negative phospholipase A2 receptor (PLA2R) antigen deposit. The numbers of at‐risk patients at selected time points (3, 6, 9, 12, 15, 18, 21, 24, 27 and 30 months) were indicated below the plot. Log–rank method was used to evaluate the significance of differences
Figure 3
Figure 3
Kaplan‐Meier analysis of spontaneous remission in patients with positive and negative phospholipase A2 receptor (PLA2R) antigen deposit. The numbers of at‐risk patients at selected time points (3, 6, 9, 12, 15, 18, 21, 24, 27 and 30 months) were indicated below the plot. Log–rank method was used to evaluate the significance of differences
Figure 4
Figure 4
Kaplan‐Meier analysis of the remission of proteinuria and renal survival in phospholipase A2 receptor (PLA2R)‐associated idiopathic membranous nephropathy (IMN) patients receiving cyclophosphamide (CTX) or cyclosporine A (CsA). The numbers of at‐risk patients at selected time points (3, 6, 9, 12, 15, 18, 21, 24, 27 and 30 months) were indicated below the plot. Log–rank method was used to evaluate the significance of differences
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