Phospholipase A2 receptor autoantibodies and clinical outcome in patients with primary membranous nephropathy
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Phospholipase A2 receptor autoantibodies and clinical outcome in patients with primary membranous nephropathy. / Hoxha, Elion; Thiele, Ina; Zahner, Gunther; Panzer, Ulf; Harendza, Sigrid; Stahl, Rolf A K.
In: J AM SOC NEPHROL, Vol. 25, No. 6, 01.06.2014, p. 1357-1366.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Phospholipase A2 receptor autoantibodies and clinical outcome in patients with primary membranous nephropathy
AU - Hoxha, Elion
AU - Thiele, Ina
AU - Zahner, Gunther
AU - Panzer, Ulf
AU - Harendza, Sigrid
AU - Stahl, Rolf A K
N1 - Copyright © 2014 by the American Society of Nephrology.
PY - 2014/6/1
Y1 - 2014/6/1
N2 - Membranous nephropathy (MN) is the most common cause of nephrotic syndrome in adults, with an uncertain clinical outcome. The characterization of the phospholipase A2 receptor (PLA2R) as the major target antigen in primary MN and the detection of circulating autoantibodies in these patients is a major advance in understanding this disease. To test whether PLA2R antibody levels reflect disease activity or clinical outcome, we performed a prospective multicenter study of 133 adult patients with primary MN and detectable serum PLA2R antibodies who had not received immunosuppressive therapy. Patients were followed ≤24 months. PLA2R antibody levels associated with clinical disease activity (proteinuria) in patients with immunosuppressive therapy (n=101) or supportive care (n=32). Within 3 months, immunosuppressive therapy led to a sustained 81% reduction in PLA2R antibody levels paralleled by a 39% reduction in proteinuria. Patients who experienced remission of proteinuria after 12 months had significantly lower PLA2R antibody levels at the time of study inclusion compared with patients with no remission. Patients with high PLA2R antibody levels achieved remission of proteinuria significantly later than patients with low PLA2R antibody levels. PLA2R antibody levels fell over time in patients with spontaneous remission but remained elevated in patients who did not show a reduction in proteinuria. Multivariable Cox regression analysis confirmed PLA2R antibody level as an independent risk factor for not achieving remission of proteinuria. We conclude that a decrease in PLA2R antibody level is associated with a decrease of proteinuria in patients with primary MN.
AB - Membranous nephropathy (MN) is the most common cause of nephrotic syndrome in adults, with an uncertain clinical outcome. The characterization of the phospholipase A2 receptor (PLA2R) as the major target antigen in primary MN and the detection of circulating autoantibodies in these patients is a major advance in understanding this disease. To test whether PLA2R antibody levels reflect disease activity or clinical outcome, we performed a prospective multicenter study of 133 adult patients with primary MN and detectable serum PLA2R antibodies who had not received immunosuppressive therapy. Patients were followed ≤24 months. PLA2R antibody levels associated with clinical disease activity (proteinuria) in patients with immunosuppressive therapy (n=101) or supportive care (n=32). Within 3 months, immunosuppressive therapy led to a sustained 81% reduction in PLA2R antibody levels paralleled by a 39% reduction in proteinuria. Patients who experienced remission of proteinuria after 12 months had significantly lower PLA2R antibody levels at the time of study inclusion compared with patients with no remission. Patients with high PLA2R antibody levels achieved remission of proteinuria significantly later than patients with low PLA2R antibody levels. PLA2R antibody levels fell over time in patients with spontaneous remission but remained elevated in patients who did not show a reduction in proteinuria. Multivariable Cox regression analysis confirmed PLA2R antibody level as an independent risk factor for not achieving remission of proteinuria. We conclude that a decrease in PLA2R antibody level is associated with a decrease of proteinuria in patients with primary MN.
KW - Adult
KW - Aged
KW - Autoantibodies
KW - Female
KW - Follow-Up Studies
KW - Glomerulonephritis, Membranous
KW - Humans
KW - Immunosuppressive Agents
KW - Male
KW - Middle Aged
KW - Nephrotic Syndrome
KW - Prognosis
KW - Prospective Studies
KW - Proteinuria
KW - Receptors, Phospholipase A2
KW - Risk Factors
KW - Seroepidemiologic Studies
KW - Serum Albumin
KW - Treatment Outcome
U2 - 10.1681/ASN.2013040430
DO - 10.1681/ASN.2013040430
M3 - SCORING: Journal article
C2 - 24610926
VL - 25
SP - 1357
EP - 1366
JO - J AM SOC NEPHROL
JF - J AM SOC NEPHROL
SN - 1046-6673
IS - 6
ER -
