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. 2021 Jul 6;14(12):2556-2562.
doi: 10.1093/ckj/sfab116. eCollection 2021 Dec.

Monitoring anti-PLA2R antibody titres to predict the likelihood of spontaneous remission of membranous nephropathy

Elias Jatem-Escalante  1 , María Luisa Martín-Conde  1 , Esther Gràcia-Lavedan  2 , Ivan D Benítez  2 , Jorge Gonzalez  1 , Laura Colás  2 , Alicia Garcia-Carrasco  2 , Cristina Martínez  2 , Alfons Segarra-Medrano  1
Affiliations

Monitoring anti-PLA2R antibody titres to predict the likelihood of spontaneous remission of membranous nephropathy

Elias Jatem-Escalante et al. Clin Kidney J. .

Abstract

Background: In anti-phospholipase A2 receptor (PLA2R) membranous nephropathy (MN) there is controversy whether spontaneous remission (SR) can be predicted using a single titre or by assessing the dynamic changes in anti-PLA2R antibody (ab) titres. The study objective was to identify the optimal dynamics of anti-PLA2Rab titres to predict SR in MN.

Methods: A total of 127 nephrotic patients with anti-PLA2R-MN were prospectively followed up for 6 months under conservative treatment. Anti-PLA2Rabs and proteinuria were assessed at diagnosis and monthly thereafter. The primary endpoint (PEP) was a reduction of proteinuria ≥50% at 6 months. Logistic models with baseline and evolutive anti-PLA2Rab titres were developed to predict the PEP.

Results: A total of 28 patients (22%) reached the PEP. These patients were more frequently female and had significantly lower baseline proteinuria and anti-PLA2Rab titres. An anti-PLA2R titre ≤97.5 RU/mL at diagnosis had a sensitivity of 71% and a specificity of 81% to predict the PEP. The model including baseline anti-PLA2Rabs and a reduction ≥15% at 3 months predicted the PEP with a sensitivity of 93% and a specificity of 80%, with an area under the curve that was significantly greater than that obtained with relative changes of proteinuria in the same period of time {odds ratio [OR] 0.95 [95% confidence interval (CI) 0.91-0.98 versus OR 0.79 [95% CI 0.70-0.88], respectively; P = 0.0013}.

Conclusions: Combining the baseline anti-PLA2Rab titres with their relative changes at 3 months after diagnosis gives the earliest prediction for achieving a reduction of urinary protein excretion ≥50% at 6 months in MN, thereby shortening the observation period currently recommended to make individualized decisions to start immunosuppressive therapy.

Keywords: anti-PLA2R antibodies; membranous nephropathy; nephrotic syndrome; prediction; spontaneous remission.

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Figures

Graphical Abstract
Graphical Abstract
FIGURE 1:
FIGURE 1:
Evolution of anti-PLA2Rab titres and proteinuria among patients according to achievement of the PEP. The values are expressed as mean ± SD with a 95% CI.
FIGURE 2:
FIGURE 2:
Evolution of the anti-PLA2Rab titres of each patient during the observation period of 6 months after diagnosis. Each one of the graphs represents the evolution of the antibody titres of each patient throughout the observation period of 6 months. The total group has been divided into deciles, based on the baseline anti-PLA2Rab titres, to allow visualization of the evolution of the antibody titres in each of them.
FIGURE 3:
FIGURE 3:
ROC curves comparing the predictive models based on anti-PLA2Rab titres and proteinuria at baseline and at 3 months.
See this image and copyright information in PMC

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