Anti-phospholipase A2 receptor antibody levels at diagnosis predicts outcome of TAC-based treatment for idiopathic membranous nephropathy patients
Abstract Background Idiopathic membranous nephropathy (iMN) is recognized as an organ-specific autoimmune disease, mainly caused by anti-PLA2R antibody. This study aimed to study between anti-PLA2R antibody level at diagnosis and the response to tacrolimus (TAC)-based treatment in iMN patients. Meth...
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| Format: | Article |
| Language: | English |
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BMC
2022-09-01
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| Series: | BMC Nephrology |
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| Online Access: | https://doi.org/10.1186/s12882-022-02914-4 |
| _version_ | 1828113210567294976 |
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| author | Bihua Wang Zhidan Zhu Feng Huang Haowen Huang Luxia Tu Ying Wang Linfeng Zheng Jing Zhou Xin Wei |
| author_facet | Bihua Wang Zhidan Zhu Feng Huang Haowen Huang Luxia Tu Ying Wang Linfeng Zheng Jing Zhou Xin Wei |
| author_sort | Bihua Wang |
| collection | DOAJ |
| description | Abstract Background Idiopathic membranous nephropathy (iMN) is recognized as an organ-specific autoimmune disease, mainly caused by anti-PLA2R antibody. This study aimed to study between anti-PLA2R antibody level at diagnosis and the response to tacrolimus (TAC)-based treatment in iMN patients. Methods This was a retrospective cohort study including 94 kidney biopsy-proven MN patients with positive anti-PLA2R antibody at diagnosis from May 2017 to September 2021 in our center. All iMN patients received the TAC regimen as the initial immunosuppressive therapy. All patients were divided into two groups according to anti-PLA2R antibody titer at diagnosis: high-level group (> 150 RU/ml; n = 42) and low-level group (≤ 150 RU/ml; n = 52). The association between anti-PLA2R antibody levels and clinical outcomes was assessed using the Kaplan–Meier method. Results The low density lipoprotein in the high-level group was significantly higher than low-level group at diagnosis, otherwise, serum albumin was significantly lower than low-level group; however, there was no significant difference in creatinine levels between two groups. The remission rates were significantly higher in the low-level group than high-level group after treatment with TAC for 12, 18, or 24 months (all P < 0.05). After 12 months of treatment with TAC, 82.7% of the patients in the low-level group achieved complete remission (CR) or partial remission (PR) (mean, 6.52 ± 0.53 months). However, 38.1% of the patients in high-level group achieved CR or PR (mean, 9.86 ± 0.51 months). Moreover, CR rate at 12 months in the high-level group was only 4.7% (mean, 11.88 ± 0.63 months). The infection frequency in the high-level group (35.6%) was higher than the low-level group (20%) during the TAC treatment, although there was no significant difference (P = 0.065). There were 19% patients who had end-stage kidney disease (ESKD), and 7.1% of patients died of ESKD in the high-level group during the follow-up period. Conclusion Anti-PLA2R antibody level above 150 RU/ml at diagnosis can predict a poor treatment response and outcome of TAC treatment in iMN patients, who may not benefit from TAC or other calcineurin inhibitor regimens as the initial treatment. |
| first_indexed | 2024-04-11T12:02:58Z |
| format | Article |
| id | doaj.art-829c143d068e4d218c334e4113114d03 |
| institution | Directory Open Access Journal |
| issn | 1471-2369 |
| language | English |
| last_indexed | 2024-04-11T12:02:58Z |
| publishDate | 2022-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj.art-829c143d068e4d218c334e4113114d032022-12-22T04:24:48ZengBMCBMC Nephrology1471-23692022-09-012311910.1186/s12882-022-02914-4Anti-phospholipase A2 receptor antibody levels at diagnosis predicts outcome of TAC-based treatment for idiopathic membranous nephropathy patientsBihua Wang0Zhidan Zhu1Feng Huang2Haowen Huang3Luxia Tu4Ying Wang5Linfeng Zheng6Jing Zhou7Xin Wei8Department of Nephrology, The First Affiliated Hospital of Nanchang UniversityDepartment of Nephrology, The First Affiliated Hospital of Nanchang UniversityDepartment of Nephrology, The First Affiliated Hospital of Nanchang UniversityDepartment of Nephrology, People’s Hospital of Ganjiang New DistrictPathology Department, The First Affiliated Hospital of Nanchang UniversityDepartment of Nephrology, The First Affiliated Hospital of Nanchang UniversityDepartment of Nephrology, The First Affiliated Hospital of Nanchang UniversityDepartment of Nephrology, The First Affiliated Hospital of Nanchang UniversityDepartment of Nephrology, The First Affiliated Hospital of Nanchang UniversityAbstract Background Idiopathic membranous nephropathy (iMN) is recognized as an organ-specific autoimmune disease, mainly caused by anti-PLA2R antibody. This study aimed to study between anti-PLA2R antibody level at diagnosis and the response to tacrolimus (TAC)-based treatment in iMN patients. Methods This was a retrospective cohort study including 94 kidney biopsy-proven MN patients with positive anti-PLA2R antibody at diagnosis from May 2017 to September 2021 in our center. All iMN patients received the TAC regimen as the initial immunosuppressive therapy. All patients were divided into two groups according to anti-PLA2R antibody titer at diagnosis: high-level group (> 150 RU/ml; n = 42) and low-level group (≤ 150 RU/ml; n = 52). The association between anti-PLA2R antibody levels and clinical outcomes was assessed using the Kaplan–Meier method. Results The low density lipoprotein in the high-level group was significantly higher than low-level group at diagnosis, otherwise, serum albumin was significantly lower than low-level group; however, there was no significant difference in creatinine levels between two groups. The remission rates were significantly higher in the low-level group than high-level group after treatment with TAC for 12, 18, or 24 months (all P < 0.05). After 12 months of treatment with TAC, 82.7% of the patients in the low-level group achieved complete remission (CR) or partial remission (PR) (mean, 6.52 ± 0.53 months). However, 38.1% of the patients in high-level group achieved CR or PR (mean, 9.86 ± 0.51 months). Moreover, CR rate at 12 months in the high-level group was only 4.7% (mean, 11.88 ± 0.63 months). The infection frequency in the high-level group (35.6%) was higher than the low-level group (20%) during the TAC treatment, although there was no significant difference (P = 0.065). There were 19% patients who had end-stage kidney disease (ESKD), and 7.1% of patients died of ESKD in the high-level group during the follow-up period. Conclusion Anti-PLA2R antibody level above 150 RU/ml at diagnosis can predict a poor treatment response and outcome of TAC treatment in iMN patients, who may not benefit from TAC or other calcineurin inhibitor regimens as the initial treatment.https://doi.org/10.1186/s12882-022-02914-4Anti-PLA2R antibodyIdiopathic membranous nephropathyTACTreatment responseOutcome |
| spellingShingle | Bihua Wang Zhidan Zhu Feng Huang Haowen Huang Luxia Tu Ying Wang Linfeng Zheng Jing Zhou Xin Wei Anti-phospholipase A2 receptor antibody levels at diagnosis predicts outcome of TAC-based treatment for idiopathic membranous nephropathy patients BMC Nephrology Anti-PLA2R antibody Idiopathic membranous nephropathy TAC Treatment response Outcome |
| title | Anti-phospholipase A2 receptor antibody levels at diagnosis predicts outcome of TAC-based treatment for idiopathic membranous nephropathy patients |
| title_full | Anti-phospholipase A2 receptor antibody levels at diagnosis predicts outcome of TAC-based treatment for idiopathic membranous nephropathy patients |
| title_fullStr | Anti-phospholipase A2 receptor antibody levels at diagnosis predicts outcome of TAC-based treatment for idiopathic membranous nephropathy patients |
| title_full_unstemmed | Anti-phospholipase A2 receptor antibody levels at diagnosis predicts outcome of TAC-based treatment for idiopathic membranous nephropathy patients |
| title_short | Anti-phospholipase A2 receptor antibody levels at diagnosis predicts outcome of TAC-based treatment for idiopathic membranous nephropathy patients |
| title_sort | anti phospholipase a2 receptor antibody levels at diagnosis predicts outcome of tac based treatment for idiopathic membranous nephropathy patients |
| topic | Anti-PLA2R antibody Idiopathic membranous nephropathy TAC Treatment response Outcome |
| url | https://doi.org/10.1186/s12882-022-02914-4 |
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