Anti-phospholipase A₂ receptor antibodies in recurrent membranous nephropathy.

Abstract

About 70% of patients with primary membranous nephropathy (MN) have circulating anti-phospholipase A2 receptor (PLA2R) antibodies that correlate with disease activity, but their predictive value in post-transplant (Tx) recurrent MN is uncertain. We evaluated 26 patients, 18 with recurrent MN and 8 without recurrence, with serial post-Tx serum samples and renal biopsies to determine if patients with pre-Tx anti-PLA2R are at increased risk of recurrence as compared to seronegative patients and to determine if post-Tx changes in anti-PLA2R correspond to the clinical course. In the recurrent group, 10/17 patients had anti-PLA2R at the time of Tx versus 2/7 patients in the nonrecurrent group. The positive predictive value of pre-Tx anti-PLA2R for recurrence was 83%, while the negative predictive value was 42%. Persistence or reappearance of post-Tx anti-PLA2R was associated with increasing proteinuria and resistant disease in 6/18 cases; little or no proteinuria occurred in cases with pre-Tx anti-PLA2R and biopsy evidence of recurrence in which the antibodies resolved with standard immunosuppression. Some cases with positive pre-Tx anti-PLA2R were seronegative at the time of recurrence. In conclusion, patients with positive pre-Tx anti-PLA2R should be monitored closely for recurrent MN. Persistence or reappearance of antibody post-Tx may indicate a more resistant disease.

• Authors: A Kattah, R Ayalon, L H Beck Jr, S Sethi, D G Sandor, F G Cosio, M J Gandhi, E C Lorenz, D J Salant, F C Fervenza
• Journal: American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons (Am J Transplant) Vol. 15 Issue 5 Pg. 1349-59 (May 2015) ISSN: 1600-6143 [Electronic] United States
• PMID: 25766759 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.

Chemical References

• Immunosuppressive Agents
• Receptors, Phospholipase A2

Topics

• Adult
• Aged
• Biopsy
• Female
• Glomerulonephritis, Membranous (immunology)
• Graft Survival
• Humans
• Immunosuppression Therapy (methods)
• Immunosuppressive Agents (therapeutic use)
• Kidney Failure, Chronic (surgery)
• Longitudinal Studies
• Male
• Middle Aged
• Predictive Value of Tests
• Proteinuria (immunology)
• Receptors, Phospholipase A2 (chemistry, immunology)
• Recurrence
• Retrospective Studies
• Treatment Outcome