Abstract
Abstract Background and Aims Membranous nephropathy (MN) is known to affect frequently in elderly patients. Since the duration of MN treatment is likely to be prolonged, it is desirable that the treatment duration would be shortened by the concomitant use of immunosuppressant and prednisolone (PSL). Therefore, we evaluated prognostic factors using the results of treatment in a very short period of time in patients with membrane nephropathy at our hospital. Method Biopsy-proven 66 cases with MN, hospitalized between April 2009 and December 2017, were enrolled in this study. All cases were divided between two groups, high responder and low responder, based on the 50% proteinuria-reduction ratio at a month after the beginning of therapy including sole administration of PSL and concomitant use of immunosuppressants such as Cyclosporin or Mizoribine. High responder and low responder were comparatively studied. All biopsy specimens were stained by anti-phospholipase A2 receptor (PLA2R) and thrombospondin type 1 domain containing 7A (THSD7A) antibodies by standard protocol. Results Estimated glomerular filtration rate (eGFR) was 70.5 vs 60.4 ml/min (p = 0.087), showing no difference. Baseline urine protein-to-Cr ratio (PCR) and degree of hematuria in high responder were significantly higher than those in low responder; baseline PCR: (6.95 vs 3.86, p = 0.003), degree of hematuria: (1 vs 0, p = 0.036) There was no difference in intensity of immunofluorescent staining of IgG, A, M, C3 between high responder and low responder. We also studied the difference in immunofluorescent intensity of PLA2R, THSD7A and IgG subclass. Intensity of IgG3 and ratio of PLA2R/IgG4 intensity in low responder were significantly higher than those in high responder; IgG3 intensity: (0 vs 0.5, p = 0.049), PLA2R/IgG4 ratio: (0.58 vs 1.00, p = 0.029) Conclusion Obtained results showed that higher baseline PCR and degree of hematuria might be related to the rapid therapeutical response. On the other hand, higher staining intensity of IgG3 and PLA2R/IgG4 intensity ratio might reduce the response of treatment.
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