Neural epidermal growth factor-like 1 expression predicts end-stage renal disease in phospholipase A2 receptor-negative membranous nephropathy: A retrospective cohort stratified by systemic lupus erythematosus.

Abstract

BackgroundNeural epidermal growth factor-like 1 protein has emerged as a significant antigen in membranous nephropathy, an important cause of nephrotic syndrome in adults. However, the prognosis of neural epidermal growth factor-like 1-associated membranous nephropathy remains limited and requires further exploration.MethodsA Chinese retrospective cohort of 446 patients diagnosed with membranous nephropathy on renal biopsy was categorized into phospholipase A2 receptor-associated (n = 358) and phospholipase A2 receptor-negative (n = 88) membranous nephropathy groups. The phospholipase A2 receptor-negative group was subjected to neural epidermal growth factor-like 1 fluorescence staining. Multivariate regression analyses, stratified analyses, and Kaplan-Meier analyses were used to explore the correlation of neural epidermal growth factor-like 1 with the risk of end-stage renal disease.ResultsWe identified 11 cases of neural epidermal growth factor-like 1-associated membranous nephropathy, accounting for 12.7% of phospholipase A2 receptor-negative membranous nephropathy cases. These patients were predominantly young women with a history of fairness cream use. In patients with phospholipase A2 receptor-negative membranous nephropathy, multivariable regression analysis showed that the neural epidermal growth factor-like 1-positive group had a higher risk of end-stage renal disease compared with the neural epidermal growth factor-like 1-negative group (hazard ratio = 3.2, p = 0.026). Stratified analysis showed that this association was particularly significant in patients with systemic lupus erythematosus (hazard ratio = 5.1, p = 0.041). Kaplan-Meier analysis also revealed a higher risk in neural epidermal growth factor-like 1-positive patients (p = 0.003).ConclusionNeural epidermal growth factor-like 1 expression is an independent risk factor for end-stage renal disease, especially in patients with systemic lupus erythematosus, with an incidence rate of approximately 12.7% in patients with phospholipase A2 receptor-negative membranous nephropathy.