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Monitoring anti-PLA2R antibody titres to predict the likelihood of spontaneous remission of membranous nephropathy
BACKGROUND: In anti-phospholipase A2 receptor (PLA2R) membranous nephropathy (MN) there is controversy whether spontaneous remission (SR) can be predicted using a single titre or by assessing the dynamic changes in anti-PLA2R antibody (ab) titres. The study objective was to identify the optimal dyna...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8690096/ https://www.ncbi.nlm.nih.gov/pubmed/34950467 http://dx.doi.org/10.1093/ckj/sfab116 |
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author | Jatem-Escalante, Elias Martín-Conde, María Luisa Gràcia-Lavedan, Esther Benítez, Ivan D Gonzalez, Jorge Colás, Laura Garcia-Carrasco, Alicia Martínez, Cristina Segarra-Medrano, Alfons |
author_facet | Jatem-Escalante, Elias Martín-Conde, María Luisa Gràcia-Lavedan, Esther Benítez, Ivan D Gonzalez, Jorge Colás, Laura Garcia-Carrasco, Alicia Martínez, Cristina Segarra-Medrano, Alfons |
author_sort | Jatem-Escalante, Elias |
collection | PubMed |
description | BACKGROUND: In anti-phospholipase A2 receptor (PLA2R) membranous nephropathy (MN) there is controversy whether spontaneous remission (SR) can be predicted using a single titre or by assessing the dynamic changes in anti-PLA2R antibody (ab) titres. The study objective was to identify the optimal dynamics of anti-PLA2Rab titres to predict SR in MN. METHODS: A total of 127 nephrotic patients with anti-PLA2R-MN were prospectively followed up for 6 months under conservative treatment. Anti-PLA2Rabs and proteinuria were assessed at diagnosis and monthly thereafter. The primary endpoint (PEP) was a reduction of proteinuria ≥50% at 6 months. Logistic models with baseline and evolutive anti-PLA2Rab titres were developed to predict the PEP. RESULTS: A total of 28 patients (22%) reached the PEP. These patients were more frequently female and had significantly lower baseline proteinuria and anti-PLA2Rab titres. An anti-PLA2R titre ≤97.5 RU/mL at diagnosis had a sensitivity of 71% and a specificity of 81% to predict the PEP. The model including baseline anti-PLA2Rabs and a reduction ≥15% at 3 months predicted the PEP with a sensitivity of 93% and a specificity of 80%, with an area under the curve that was significantly greater than that obtained with relative changes of proteinuria in the same period of time {odds ratio [OR] 0.95 [95% confidence interval (CI) 0.91–0.98 versus OR 0.79 [95% CI 0.70–0.88], respectively; P = 0.0013}. CONCLUSIONS: Combining the baseline anti-PLA2Rab titres with their relative changes at 3 months after diagnosis gives the earliest prediction for achieving a reduction of urinary protein excretion ≥50% at 6 months in MN, thereby shortening the observation period currently recommended to make individualized decisions to start immunosuppressive therapy. |
format | Online Article Text |
id | pubmed-8690096 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-86900962021-12-22 Monitoring anti-PLA2R antibody titres to predict the likelihood of spontaneous remission of membranous nephropathy Jatem-Escalante, Elias Martín-Conde, María Luisa Gràcia-Lavedan, Esther Benítez, Ivan D Gonzalez, Jorge Colás, Laura Garcia-Carrasco, Alicia Martínez, Cristina Segarra-Medrano, Alfons Clin Kidney J Original Article BACKGROUND: In anti-phospholipase A2 receptor (PLA2R) membranous nephropathy (MN) there is controversy whether spontaneous remission (SR) can be predicted using a single titre or by assessing the dynamic changes in anti-PLA2R antibody (ab) titres. The study objective was to identify the optimal dynamics of anti-PLA2Rab titres to predict SR in MN. METHODS: A total of 127 nephrotic patients with anti-PLA2R-MN were prospectively followed up for 6 months under conservative treatment. Anti-PLA2Rabs and proteinuria were assessed at diagnosis and monthly thereafter. The primary endpoint (PEP) was a reduction of proteinuria ≥50% at 6 months. Logistic models with baseline and evolutive anti-PLA2Rab titres were developed to predict the PEP. RESULTS: A total of 28 patients (22%) reached the PEP. These patients were more frequently female and had significantly lower baseline proteinuria and anti-PLA2Rab titres. An anti-PLA2R titre ≤97.5 RU/mL at diagnosis had a sensitivity of 71% and a specificity of 81% to predict the PEP. The model including baseline anti-PLA2Rabs and a reduction ≥15% at 3 months predicted the PEP with a sensitivity of 93% and a specificity of 80%, with an area under the curve that was significantly greater than that obtained with relative changes of proteinuria in the same period of time {odds ratio [OR] 0.95 [95% confidence interval (CI) 0.91–0.98 versus OR 0.79 [95% CI 0.70–0.88], respectively; P = 0.0013}. CONCLUSIONS: Combining the baseline anti-PLA2Rab titres with their relative changes at 3 months after diagnosis gives the earliest prediction for achieving a reduction of urinary protein excretion ≥50% at 6 months in MN, thereby shortening the observation period currently recommended to make individualized decisions to start immunosuppressive therapy. Oxford University Press 2021-07-06 /pmc/articles/PMC8690096/ /pubmed/34950467 http://dx.doi.org/10.1093/ckj/sfab116 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of ERA-EDTA. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Original Article Jatem-Escalante, Elias Martín-Conde, María Luisa Gràcia-Lavedan, Esther Benítez, Ivan D Gonzalez, Jorge Colás, Laura Garcia-Carrasco, Alicia Martínez, Cristina Segarra-Medrano, Alfons Monitoring anti-PLA2R antibody titres to predict the likelihood of spontaneous remission of membranous nephropathy |
title | Monitoring anti-PLA2R antibody titres to predict the likelihood of spontaneous remission of membranous nephropathy |
title_full | Monitoring anti-PLA2R antibody titres to predict the likelihood of spontaneous remission of membranous nephropathy |
title_fullStr | Monitoring anti-PLA2R antibody titres to predict the likelihood of spontaneous remission of membranous nephropathy |
title_full_unstemmed | Monitoring anti-PLA2R antibody titres to predict the likelihood of spontaneous remission of membranous nephropathy |
title_short | Monitoring anti-PLA2R antibody titres to predict the likelihood of spontaneous remission of membranous nephropathy |
title_sort | monitoring anti-pla2r antibody titres to predict the likelihood of spontaneous remission of membranous nephropathy |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8690096/ https://www.ncbi.nlm.nih.gov/pubmed/34950467 http://dx.doi.org/10.1093/ckj/sfab116 |
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