Analysis of the clinical significance of serum anti-PLA2R antibodies in evaluating clinical features and therapeutic efficacy in idiopathic membranous nephropathy.

Abstract

Introduction: This study aimed to evaluate the clinical utility of serum anti-phospholipase A2 receptor (PLA2R) antibodies in assessing clinical features and therapeutic responses in idiopathic membranous nephropathy (IMN).

Methods: A retrospective analysis was conducted on 99 patients with IMN admitted to Tianjin Medical University General Hospital between August 2023 and April 2024, stratified into seronegative and seropositive groups. Baseline characteristics, biochemical parameters, anti-PLA2R antibody levels, and 3 treatment strategy outcomes were analyzed. Receiver operating characteristic curve analysis assessed the diagnostic accuracy of anti-PLA2R antibodies.

Results: Results revealed statistically significant differences in albumin and urine total protein (U-TP) between the seronegative and seropositive groups (P < .05). Compared with the seropositive group, patients in the seronegative group had a better prognosis. Compared with the tacrolimus plus methylprednisolone and cyclophosphamide plus methylprednisolone treatment regimens, the recovery of microalbuminuria, U-TP, albumin, and anti-PLA2R was greatest after treatment with rituximab, and the therapeutic effect was better. Importantly, among these 4 markers, the change in anti-PLA2R was most substantial. The receiver operating characteristic analysis identified an optimal anti-PLA2R cutoff of 15.53 ng/mL, achieving 76.77% sensitivity, 100% specificity, and an area under the curve of 93.3% (P < .001).

Discussion: These findings highlight that rituximab demonstrates substantial clinical value in improving serum albumin levels, reducing U-TP, microalbuminuria, and anti-PLA2R antibody levels in patients with IMN while also underscoring the critical role of anti-PLA2R antibodies in IMN characterization and therapeutic monitoring.