Clinical and experimental nephrology · 2025
Clinical outcomes of immunosuppressive therapy in patients with seronegative anti-PLA2R antibodies and PLA2R-related membranous nephropathy.
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Wu Di, Liu Wen, Su Zhihang, Li Kaiting, Xue Rui, Hu Haofei, Wan Qijun
Аннотация
BACKGROUND: The study aims to investigate the impact of immunosuppressive therapy on clinical outcomes in patients with baseline negative PLA2R antibody, providing new therapeutic insights for this patient population.
METHODS: This study included 133 patients with positive histological PLA2R antigen and baseline serum anti-PLA2R antibody data. ELISA (enzyme-linked immunosorbent assay) was used to measure serum anti-PLA2R antibody levels. Renal biopsy specimens were analyzed by light microscopy, immunofluorescence, and electron microscopy.
RESULTS: Among the 133 patients, 84 (63.2%) were positive for serum antibodies (SAb +) and glomerular antigen (GAg +), while 49 (36.8%) were negative for serum antibodies (SAb-) but positive for glomerular antigen (GAg +). Compared with the Sab-/GAg + group, the SAb + /GAg + group exhibited more severe clinical features compared to the SAb-/GAg + group; however, there was no significant difference in the pathological characteristics between the two groups of patients. The complete remission (CR) rate was significantly higher in the SAb-/GAg + group (67.35% vs. 33.33%, P < 0.001), with higher CR rates at 12, 24, and 36 months. The SAb-/GAg + group also had a lower relapse rate than Sab + /GAg + (12.24% vs. 36.90%, P = 0.002). In the SAb-/GAg + group, 67.3% received conservative treatment, while 32.7% underwent immunotherapy. Patients receiving immunosuppressive therapy in the SAb-/GAg + group exhibited more severe proteinuria, more impaired renal function, and higher hyperlipidemia at baseline. Compared with conservative treatment, immunotherapy improved overall remission rates (100.00% vs. 75.76%, P = 0.041) in the SAb-/GAg + group. Cox regression analysis showed that immunotherapy significantly predicted urinary protein remission (HR 3.92, 95% CI 1.58-9.70, P = 0.003).
CONCLUSION: Immunosuppressive therapy in PLA2R-related membranous nephropathy patients with severe baseline clinical manifestations may help predict urine protein remission, even if they are serum anti-PLA2R antibody negative.
METHODS: This study included 133 patients with positive histological PLA2R antigen and baseline serum anti-PLA2R antibody data. ELISA (enzyme-linked immunosorbent assay) was used to measure serum anti-PLA2R antibody levels. Renal biopsy specimens were analyzed by light microscopy, immunofluorescence, and electron microscopy.
RESULTS: Among the 133 patients, 84 (63.2%) were positive for serum antibodies (SAb +) and glomerular antigen (GAg +), while 49 (36.8%) were negative for serum antibodies (SAb-) but positive for glomerular antigen (GAg +). Compared with the Sab-/GAg + group, the SAb + /GAg + group exhibited more severe clinical features compared to the SAb-/GAg + group; however, there was no significant difference in the pathological characteristics between the two groups of patients. The complete remission (CR) rate was significantly higher in the SAb-/GAg + group (67.35% vs. 33.33%, P < 0.001), with higher CR rates at 12, 24, and 36 months. The SAb-/GAg + group also had a lower relapse rate than Sab + /GAg + (12.24% vs. 36.90%, P = 0.002). In the SAb-/GAg + group, 67.3% received conservative treatment, while 32.7% underwent immunotherapy. Patients receiving immunosuppressive therapy in the SAb-/GAg + group exhibited more severe proteinuria, more impaired renal function, and higher hyperlipidemia at baseline. Compared with conservative treatment, immunotherapy improved overall remission rates (100.00% vs. 75.76%, P = 0.041) in the SAb-/GAg + group. Cox regression analysis showed that immunotherapy significantly predicted urinary protein remission (HR 3.92, 95% CI 1.58-9.70, P = 0.003).
CONCLUSION: Immunosuppressive therapy in PLA2R-related membranous nephropathy patients with severe baseline clinical manifestations may help predict urine protein remission, even if they are serum anti-PLA2R antibody negative.