PLA2R antibody levels and clinical outcome in patients with membranous nephropathy and non-nephrotic range proteinuria under treatment with inhibitors of the reninangiotensin system,”PLoSONE

Patients with primary membranous nephropathy (MN) who experience spontaneous remission of proteinuria generally have an excellent outcome without need of immunosuppressive therapy. It is, however, unclear whether non-nephrotic proteinuria at the time of diagnosis is also associated with good prognosis since a reasonable number of these patients develop nephrotic syndrome despite blockade of the renin-angiotensin system. No clinical or laboratory parameters are available, which allow the assessment of risk for development of nephrotic proteinuria. Phospholipase A2 Receptor antibodies (PLA R-Ab) play a prominent role in the pathogenesis of primary MN and are associated with persistence of2 nephrotic proteinuria. In this study we analysed whether PLA R-Ab levels might predict development of nephrotic2 syndrome and the clinical outcome in 33 patients with biopsy-proven primary MN and non-nephrotic proteinuria under treatment with blockers of the renin-angiotensin system. PLA R-Ab levels, proteinuria and serum creatinine were measured2 every three months. Nephrotic-range proteinuria developed in 18 (55%) patients. At study start (1.261.5 months after renal biopsy and time of diagnosis), 16 (48%) patients were positive for PLA R-Ab. A multivariate analysis showed that PLA R-Ab2 2 levels were associated with an increased risk for development of nephrotic proteinuria (HR = 3.66; 95%CI: 1.39–9.64; p = 0.009). Immunosuppressive therapy was initiated more frequently in PLA R-Ab positive patients (13 of 16 patients, 81%)2 compared to PLA R-Ab negative patients (2 of 17 patients, 12%). PLA R-Ab levels are associated with higher risk for2