Application of Serum anti-phospholipase A2 receptor antibody titers in predicting clinical outcome of idiopathic membranous nephropathy

HUANG Jun; LI Jian-wen; LIANG Ming; QIN Shu-guang; ZHOU Shan-shan; FU Jun-zhou

doi:10.3969/j.issn.1001-9448.2017.09.012

Abstract：Objective To apply the serum anti-phospholipase A2 receptor (PLA2R) antibody titers in predicting clinical outcome of idiopathic membranous nephropathy (IMN).Methods An open prospective study of 50 biopsy-proven IMN patients in Guangzhou First People's Hospital between April 2012 and June 2014 were performed.Serum anti-PLA2R antibody titers were measured using an indirect immunofluorescence assay.The patients were followed up until June 2016.Results Serum anti-PLA2R antibodies were positive in 39 (78%) patients.Among them, proteinuria was significantly higher in the high titers group than in the low titers group, and antibody titer was significantly correlated with baseline proteinuria (r=0.558, P<0.001).In the first 6 months with supportive care, spontaneous remissions significantly occurred more frequently among low antibody titers patients (57.1% versus 9.1% in the low and high titers group, P<0.05).After immunosuppressive therapy, proteinuria and serum albumin levels were more rapidly improved in the low titers group.At the end of the 12th month of treatment, the probability of complete remission in the low titer group was significantly higher compared with that in the high titer group (85.7% versus 21.4%, P<0.05).During the follow-up period, the time to proteinuria remission in the low titer group was significantly shorter than that in the high titer group (P=0.001).Patients in the high titer group significantly faster loss renal function (a serum creatinine level≥133 μmol/L) than patients in the low titer group (P<0.05).Conclusion Serum anti-PLA2R antibody titer may not only serve as useful biomarkers for immunologic and disease activity of IMN patients, but also represent as a sensitive indicator of treatment efficacy and clinical outcome.