Abstract
BackgroundAccording to renal M type phospholipase A2 receptor (PLA2R) immunohistochemistry, idiopathic membranous nephropathy (IMN) could be categorized into PLA2R-associated and non-PLA2R-associated IMN. We conducted a retrospective, multicenter cohort study with 91 patients to compare the effect of immunosuppressive therapy between PLA2R-associated and non-PLA2R-associated IMN patients.MethodsA total of 91 biopsy-proven IMN patients from Huashan hospital and People’s Hospital of Wuxi in past 5 years were collected into this study. IMN with positive PLA2R immunohistochemistry in kidney biopsies were designated as PLA2R-associated IMN. Seventy-eight of the 91 IMN patients was PLA2R-associated IMN and 13 were non-PLA2R-associated IMN. Forty-five patients were treated with prednisone plus cyclophosphamide (CTX), and 46 with prednisone plus calcineurin inhibitors (CNIs). The follow-up duration was 15 months.ResultsThe total remission rate (76.9% versus 44.9%, p = 0.032) and complete remission rate (30.8% versus 2.6%, p = 0.003) were both significantly higher in the non-PLA2R-associated group than in the PLA2R-associated group at the 3rd month visit point, and at the 6th month time point, the complete remission rate was still significantly higher in the non-PLA2R-associated group (46.2% versus 11.5%,p = 0.007). But similar remission rates were found after the 9th month. Relapses were observed in 8 patients in PLA2R-associated group and none in non-PLA2R-associated group, although there was no significant difference between these two groups.ConclusionCompared with the PLA2R-associated IMN, the non-PLA2R-associated IMN responded quicker to the immunosuppressive therapy.
Highlights
According to renal M type phospholipase A2 receptor (PLA2R) immunohistochemistry, idiopathic membranous nephropathy (IMN) could be categorized into PLA2R-associated and non-PLA2R-associated IMN
Among the patients without spontaneous remission, 70–80% was reported to respond to cyclophosphamide (CTX) or calcineurin inhibitors (CNIs) and have a better outcome than those who failed to respond to immunosuppressive therapies [5,6,7,8,9]
Nine patients in CTX group were switched to CNIs (8 NR patients, 1 Partial remission (PR) patients who received transurethral resection of bladder neoplasm) and 2 patients lost to follow-up during the 15 months observation period
Summary
According to renal M type phospholipase A2 receptor (PLA2R) immunohistochemistry, idiopathic membranous nephropathy (IMN) could be categorized into PLA2R-associated and non-PLA2R-associated IMN. Our previous study as well as others has shown that most of the patients who have positive serum PLA2R-Ab have detectable PLA2R expression in the kidney along capillary loops; while those who have a positive PLA2R in the kidney tissue do not necessarily have positive serum PLA2R-Ab [15] These data may suggest that kidney PLA2R expression is a more reliable marker for PLA2R-associated IMN, since serum PLA2R-Ab may turn negative in situations such as automatic remission or following treatment [15,16,17,18]. We used renal PLA2R to classify IMN into PLA2R-associated and non-PLA2R-associated IMN and examine whether there was any difference in response to immunosuppressive therapy between these two groups
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