1. Monitoring anti-PLA2R antibody titres to predict the likelihood of spontaneous remission of membranous nephropathy
- Author
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Elias Jatem-Escalante, Cristina Martínez, Jorge González, Alicia Garcia-Carrasco, Iván Benítez, Maria Luisa Martin-Conde, Esther Gracia-Lavedan, Alfons Segarra-Medrano, Laura Colás, Institut Català de la Salut, [Jatem-Escalante E, Martín-Conde ML] Servicio de Nefrología, Hospital Universitario Arnau de Vilanova, Lleida, Spain. Institut de Recerca Biomèdica, Lleida, Spain. [Gràcia-Lavedan E, Benítez ID] Institut de Recerca Biomèdica, Lleida, Spain. Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain. [Gonzalez J] Servicio de Nefrología, Hospital Universitario Arnau de Vilanova, Lleida, Spain. [Colás L] Institut de Recerca Biomèdica, Lleida, Spain. [Segarra-Medrano A] Servicio de Nefrología, Hospital Universitario Arnau de Vilanova, Lleida, Spain. Institut de Recerca Biomèdica, Lleida, Spain. Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain, and Vall d'Hebron Barcelona Hospital Campus
- Subjects
medicine.medical_specialty ,Membranous nephropathy ,030232 urology & nephrology ,Otros calificadores::/diagnóstico [Otros calificadores] ,Nephrotic syndrome ,aminoácidos, péptidos y proteínas::proteínas::proteínas sanguíneas::inmunoproteínas::inmunoglobulinas::anticuerpos::autoanticuerpos [COMPUESTOS QUÍMICOS Y DROGAS] ,Spontaneous remission ,Autoanticossos ,030204 cardiovascular system & hematology ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Ronyons - Malalties - Diagnòstic ,Other subheadings::/diagnosis [Other subheadings] ,Medicine ,AcademicSubjects/MED00340 ,Transplantation ,biology ,business.industry ,nephrotic syndrome ,spontaneous remission ,membranous nephropathy ,prediction ,medicine.disease ,Amino Acids, Peptides, and Proteins::Proteins::Blood Proteins::Immunoproteins::Immunoglobulins::Antibodies::Autoantibodies [CHEMICALS AND DRUGS] ,Nephrology ,Immune System Diseases::Autoimmune Diseases::Glomerulonephritis, Membranous [DISEASES] ,enfermedades del sistema inmune::enfermedades autoinmunes::glomerulonefritis membranosa [ENFERMEDADES] ,biology.protein ,Original Article ,Antibody ,business ,Prediction ,Anti-PLA2R antibodies ,anti-PLA2R antibodies - 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., Graphical Abstract Graphical Abstract
- Published
- 2021