Ramachandran R, Yadav A K, Kumar V, Inamdar N, Nada R, Gupta K L, Jha V
Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Kidney Int Rep. 2017 Sep 14;3(1):142-147. doi: 10.1016/j.ekir.2017.09.001. eCollection 2018 Jan.
Autoantibodies to M-type phospholipase A2 receptor (aPLA2R) are seen in two-thirds of patients with primary membranous nephropathy (PMN) and are associated with disease activity. However, the precise temporal dynamics between the presence and amount of aPLA2R in circulation, as well as the clinical activity, are not known. We evaluated the temporal association between disease activity and serum aPLA2R during and after treatment in PMN.
The study included all patients with PMN and elevated aPLA2R who were started on immunosuppressive therapy for persistent nephrotic syndrome at a single center between December 2014 and December 2015. Serum samples were tested for aPLA2R at baseline and at monthly intervals for 6 months. Clinical details were collected monthly for 9 months. Serological remission was defined as negative aPLA2R in 2 consecutive samples. Clinical remission was defined by standard criteria.
A total of 30 patients with PMN were studied. Of these, 28 (93%) had elevated levels at baseline, whereas 2 (7%) became positive after 1 month. The mean age was 33.2 ± 1 (range, 13-52) years. Median baseline aPLA2R titer was 163.41 (range, 70-291.01) RU/ml. A total of 24 patients (80%) achieved serological remission by 6 months. Among all the serological responders, 54% had achieved negative aPLA2R by the end of the first month. Clinical remission was observed in 20 patients (67%). Serological and clinical remission were noted at 2.7 ± 1.71 and 5.05 ± 2.64 months, respectively.
In patients with aPLA2R-associated PMN, reduction in circulating aPLA2R precedes clinical remission. Persistence of aPLA2R at the end of therapy is associated with clinical resistance.
原发性膜性肾病（PMN）患者中有三分之二可检测到抗M型磷脂酶A2受体（aPLA2R）自身抗体，且其与疾病活动相关。然而，循环中aPLA2R的存在、数量与临床活动之间的确切时间动态关系尚不清楚。我们评估了PMN治疗期间及治疗后疾病活动与血清aPLA2R之间的时间关联。
本研究纳入了2014年12月至2015年12月期间在单一中心开始接受免疫抑制治疗以治疗持续性肾病综合征的所有PMN患者且aPLA2R升高。在基线及之后6个月每月检测血清样本中的aPLA2R。连续9个月每月收集临床细节。血清学缓解定义为连续2个样本中aPLA2R为阴性。临床缓解依据标准标准定义。
共研究了30例PMN患者。其中，28例（93%）在基线时水平升高，而2例（7%）在1个月后转为阳性。平均年龄为33.2±1（范围13 - 52）岁。基线aPLA2R滴度中位数为163.41（范围70 - 291.01）RU/ml。共有24例患者（80%）在6个月时达到血清学缓解。在所有血清学缓解者中，54%在第一个月末aPLA2R转为阴性。20例患者（67%）观察到临床缓解。血清学和临床缓解分别在2.7±1.71个月和5.05±2.64个月时出现。
在aPLA2R相关的PMN患者中，循环中aPLA2R的降低先于临床缓解。治疗结束时aPLA2R的持续存在与临床抵抗相关。
