Predictive value of the domain specific PLA2R antibodies for clinical remission in patients with primary membranous nephropathy
A retrospective study of 87 patients found that antibodies against a specific PLA2R domain (CTLD1-IgG4) predicted remission of membranous nephropathy better than total PLA2R antibody levels, and that cyclophosphamide produced earlier immunological remission than rituximab.
Study design
This retrospective analysis of 87 patients with PLA2R-associated primary membranous nephropathy compared rituximab (n=40) and cyclophosphamide (n=47), using time-resolved fluorescence immunoassays to measure IgG and IgG4 against PLA2R and its specific domains, and built a remission-prediction nomogram.
Key findings
Proteinuria remission rates at 6 months were similar (70% vs 70%), but immunological remission of PLA2R-IgG4 was more frequent with cyclophosphamide (62% vs 21%). Higher urinary protein and higher PLA2R-CTLD1-IgG4 were independent factors for early remission, and the domain-specific antibody outperformed total PLA2R-IgG as a predictor (model AUC 0.72).
Clinical implications
Epitope-level PLA2R antibody testing may sharpen prognostication and treatment selection, and cyclophosphamide may induce faster immunological remission than rituximab within the first 6 months in selected patients.
Category
Research
Source
PLOS ONE
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