Spontaneous remission of proteinuria is a frequent event in phospholipase A2 receptor antibody-negative patients with membranous nephropathy.

Abstract

BACKGROUND:

Phospholipase A2 receptor antibodies (PLA2R-Ab) and thrombospondin type-1 domain-containing 7A antibodies (THSD7A-Ab) are present in 70-80% of patients with membranous nephropathy (MN). Little, however, is known about the pathogenesis of MN and the clinical outcome in PLA2R-Ab- and THSD7A-Ab-negative patients.

METHODS:

In this prospective multicentre observational study, the clinical outcome of 37 patients with biopsy-proven MN who were negative for PLA2R-Ab and THSD7A-Ab in the serum was analysed.

RESULTS:

A total of 198 patients were screened for inclusion in the study. Of these, 157 patients were positive for PLA2R-Ab and 4 patients for THSD7A-Ab. The remaining 37 patients were negative for both antibodies were and included in this study. Six patients died during the follow-up, five because of malignant diseases and one of an infection. One patient went into end-stage renal disease, and two patients were lost to follow-up. The remaining 28 patients were followed for at least 24 months (35.6 ± 8.9 months). Seventeen patients received immunosuppressive (IS) therapy, and 11 received supportive care only. At the end of the follow-up, 14 of the 17 patients treated with immunosuppressants and 10 of 11 patients on supportive therapy had a remission of proteinuria. The time to reach remission of proteinuria and serum creatinine levels at the end of the follow-up were not different between both groups. A univariate Cox regression analysis indicated that the use of immunosuppression did not alter the chance to reach a remission of proteinuria.

CONCLUSIONS:

A high number of PLA2R-Ab- and THSD7A-Ab-negative patients with MN have a good prognosis and might not need IS therapy.

• Authors: Elion Hoxha, Sigrid Harendza, Hans O Pinnschmidt, Nicola M Tomas, Udo Helmchen, Ulf Panzer, Rolf A K Stahl
• Journal: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association (Nephrol Dial Transplant) Vol. 30 Issue 11 Pg. 1862-9 (Nov 2015) ISSN: 1460-2385 [Electronic] England
• PMID: 26142398 (Publication Type: Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: © The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Chemical References

• Autoantibodies
• Receptors, Phospholipase A2
• THSD7A protein, human
• Thrombospondins

Topics

• Adult
• Aged
• Autoantibodies (blood)
• Female
• Glomerulonephritis, Membranous (physiopathology)
• Humans
• Male
• Middle Aged
• Prospective Studies
• Proteinuria (etiology, physiopathology)
• Receptors, Phospholipase A2 (immunology)
• Remission, Spontaneous
• Thrombospondins (immunology)
• Treatment Outcome
• Young Adult