Anti-PLA2R IgG4-to-IgG Ratio Helps Predict Remission of PLA2R-Associated Primary Membranous Nephropathy.

IF 3.2 3区医学 Q1 UROLOGY & NEPHROLOGY

American Journal of Nephrology Pub Date : 2025-08-04 DOI:10.1159/000547713

Yuting Liu, Zhenling Deng, Zihan Wang, Shang Gao, Tianyu Zheng, Danxia Zheng, Song Wang, Biao Huang, Yue Wang

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引用次数: 0

Abstract

Introduction: PLA2R-associated primary membranous nephropathy (PMN) was classified as IgG4-associated autoimmune disease, in which anti-PLA2R antibody is predominantly IgG4 subclass. Our objective was to explore the capability of anti-PLA2R IgG4-to-IgG ratio for predicting remission in PLA2R-associated PMN patients.

Methods: A total of 143 patients with anti-PLA2R IgG ≥14 RU/mL were biopsy-confirmed as PLA2R-associated PMN. Serum samples collected at the time of renal biopsy were tested for anti-PLA2R IgG and anti-PLA2R IgG4 using time-resolved fluoroimmunoassay. The anti-PLA2R IgG4-to-IgG ratio was calculated as anti-PLA2R IgG4 (ng/mL) divided by anti-PLA2R IgG (RU/mL). Patients were divided into high-ratio and low-ratio groups by cutoff value of 31.5 ng/RU determined by the maximally selected log-rank statistic. The relationship between anti-PLA2R IgG4-to-IgG ratio and remission was analyzed using Cox proportional hazard regression.

Results: Compared to the low-ratio group, patients in the high-ratio group were significantly younger (52 [40-60] vs. 58 [51-61] years, p = 0.035), had higher estimated glomerular filtration rate (102 [88-111] vs. 94 [72-100] mL/min/1.73 m2, p = 0.004), and obtained higher 6-month partial remission rates (64.6% vs. 30.0%, p = 0.001) and 1-year complete remission rates (38.3% vs. 7.7%, p = 0.003). The higher remission rates with high ratio remained in both moderate-low-risk and high-risk subgroups categorized according to KDIGO 2021 guidelines. The anti-PLA2R IgG4-to-IgG ratio had a significant positive relation with partial remission (hazard ratio [95% confidence interval] = 2.09 [1.27-3.46], p = 0.004), which also persisted across both risk subgroups. Kaplan-Meier survival curves confirmed the significantly higher possibility of partial remission in the high-ratio group.

Conclusion: An elevated anti-PLA2R IgG4-to-IgG ratio may be a supplementary predictor for remission in PLA2R-associated PMN.

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抗pla2r igg4 - igg比值有助于预测pla2r相关原发性膜性肾病的缓解。

背景和目的：pla2r相关的原发性膜性肾病（PMN）被归类为IgG4相关的自身免疫性疾病，其中抗pla2r抗体主要是IgG4亚类。我们的目的是探索抗pla2r igg4 - igg比值预测pla2r相关PMN患者缓解的能力。方法：143例抗pla2r IgG≥14 RU/ml的患者活检证实为pla2r相关PMN。采用时间分辨荧光免疫法检测肾活检时收集的血清中抗pla2r IgG和抗pla2r IgG4的含量。抗pla2r IgG4与IgG的比值计算为抗pla2r IgG4 （ng/ml）除以抗pla2r IgG （RU/ml）。根据最大选择的log-rank统计量确定截断值31.5 ng/RU，将患者分为高比率组和低比率组。采用Cox比例风险回归分析抗pla2r igg4 - igg比值与缓解的关系。结果：与低比值组相比，高比值组患者明显更年轻（52[40-60]比58[51-61]岁，p=0.035）， eGFR更高（102[88-111]比94 [72-100]ml/min/1.73m2, p=0.004）， 6个月部分缓解率更高（64.6%比30.0%,p=0.001）， 1年完全缓解率更高（38.3%比7.7%,p=0.003）。根据KDIGO 2021指南分类的中低风险和高风险亚组中，高比率的较高缓解率仍然存在。抗pla2r igg4 - igg比值与部分缓解呈显著正相关（HR [95%CI] = 2.09 [1.27-3.46], p=0.004），在两个风险亚组中也持续存在。Kaplan-Meier生存曲线证实，高比值组部分缓解明显更高。结论：抗pla2r igg4 - igg比值升高可能是pla2r相关PMN缓解的补充预测因子。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Nephrology 医学-泌尿学与肾脏学

CiteScore

7.50

自引率

2.40%

发文量

审稿时长

4-8 weeks

期刊介绍： The ''American Journal of Nephrology'' is a peer-reviewed journal that focuses on timely topics in both basic science and clinical research. Papers are divided into several sections, including: