Xue Li, Yang Shen, Yanchun Li, Lijie Ma, Qianmei Sun
{"title":"血清中 PLA2R 抗体阴性患者中 PLA2R 相关特发性膜性肾病的临床病理特征和预后。","authors":"Xue Li, Yang Shen, Yanchun Li, Lijie Ma, Qianmei Sun","doi":"10.1080/0886022X.2023.2297015","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Idiopathic membranous nephropathy (IMN) with deposits of phospholipase A2 receptor (PLA2R) antigen in glomerular tissue (GAg+) but no circulating serum PLA2R antibody (SAb-) has been reported. However, little is known about the clinicopathological characteristics and prognosis of this subtype.</p><p><strong>Methods: </strong>A total of 74 IMN patients with GAg + identified by kidney biopsy were enrolled in this study. We categorized patients into two groups based on the presence or absence of serum PLA2R antibody. Data on clinical features, pathological features, and outcomes were collected. Kaplan-Meier analysis of complete remission (CR) and partial remission (PR) comparing SAb-/GAg + and SAb+/GAg + patients. Cox proportional hazards models was used to examine factors associated with CR and PR.</p><p><strong>Results: </strong>Among 74 IMN patients, 14 were SAb-/GAg+. Compared with SAb+/GAg + patients, SAb-/GAg + patients presented with higher levels of albumin, lower levels of cholesterol and low density lipoprotein cholesterol (all <i>p</i> < .01), but similar pathological manifestations of kidney biopsy. Multivariate logistic analyses indicated that low albumin (0.79 [95%CI: 0.66-0.95], <i>p</i> = .01) and high cholesterol (1.81 [95%CI: 1.02-3.19], <i>p</i> = .04) were correlated with seropositivity of PLA2R antibody. SAb-/GAg + patients exhibited a significantly higher probability of CR (<i>p</i> = .03) than patients who were SAb+/GAg+. However, no difference was found in the PR rate. Cox regression analyses showed that compared to SAb+/GAg + patients, SAb-/GAg + was more predictive of complete remission (4.28 [95%CI: 1.01-18.17], <i>p</i> = .04).</p><p><strong>Conclusion: </strong>IMN with PLA2R staining on kidney biopsy but without serum PLA2R antibody has milder clinical manifestations and a better prognosis.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"46 1","pages":"2297015"},"PeriodicalIF":3.0000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10823883/pdf/","citationCount":"0","resultStr":"{\"title\":\"Clinicopathological characteristics and outcomes of PLA2R related idiopathic membranous nephropathy in patients with seronegative PLA2R antibodies.\",\"authors\":\"Xue Li, Yang Shen, Yanchun Li, Lijie Ma, Qianmei Sun\",\"doi\":\"10.1080/0886022X.2023.2297015\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Idiopathic membranous nephropathy (IMN) with deposits of phospholipase A2 receptor (PLA2R) antigen in glomerular tissue (GAg+) but no circulating serum PLA2R antibody (SAb-) has been reported. However, little is known about the clinicopathological characteristics and prognosis of this subtype.</p><p><strong>Methods: </strong>A total of 74 IMN patients with GAg + identified by kidney biopsy were enrolled in this study. We categorized patients into two groups based on the presence or absence of serum PLA2R antibody. Data on clinical features, pathological features, and outcomes were collected. Kaplan-Meier analysis of complete remission (CR) and partial remission (PR) comparing SAb-/GAg + and SAb+/GAg + patients. Cox proportional hazards models was used to examine factors associated with CR and PR.</p><p><strong>Results: </strong>Among 74 IMN patients, 14 were SAb-/GAg+. Compared with SAb+/GAg + patients, SAb-/GAg + patients presented with higher levels of albumin, lower levels of cholesterol and low density lipoprotein cholesterol (all <i>p</i> < .01), but similar pathological manifestations of kidney biopsy. Multivariate logistic analyses indicated that low albumin (0.79 [95%CI: 0.66-0.95], <i>p</i> = .01) and high cholesterol (1.81 [95%CI: 1.02-3.19], <i>p</i> = .04) were correlated with seropositivity of PLA2R antibody. SAb-/GAg + patients exhibited a significantly higher probability of CR (<i>p</i> = .03) than patients who were SAb+/GAg+. However, no difference was found in the PR rate. Cox regression analyses showed that compared to SAb+/GAg + patients, SAb-/GAg + was more predictive of complete remission (4.28 [95%CI: 1.01-18.17], <i>p</i> = .04).</p><p><strong>Conclusion: </strong>IMN with PLA2R staining on kidney biopsy but without serum PLA2R antibody has milder clinical manifestations and a better prognosis.</p>\",\"PeriodicalId\":20839,\"journal\":{\"name\":\"Renal Failure\",\"volume\":\"46 1\",\"pages\":\"2297015\"},\"PeriodicalIF\":3.0000,\"publicationDate\":\"2024-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10823883/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Renal Failure\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1080/0886022X.2023.2297015\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/26 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Renal Failure","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1080/0886022X.2023.2297015","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/26 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
Clinicopathological characteristics and outcomes of PLA2R related idiopathic membranous nephropathy in patients with seronegative PLA2R antibodies.
Background: Idiopathic membranous nephropathy (IMN) with deposits of phospholipase A2 receptor (PLA2R) antigen in glomerular tissue (GAg+) but no circulating serum PLA2R antibody (SAb-) has been reported. However, little is known about the clinicopathological characteristics and prognosis of this subtype.
Methods: A total of 74 IMN patients with GAg + identified by kidney biopsy were enrolled in this study. We categorized patients into two groups based on the presence or absence of serum PLA2R antibody. Data on clinical features, pathological features, and outcomes were collected. Kaplan-Meier analysis of complete remission (CR) and partial remission (PR) comparing SAb-/GAg + and SAb+/GAg + patients. Cox proportional hazards models was used to examine factors associated with CR and PR.
Results: Among 74 IMN patients, 14 were SAb-/GAg+. Compared with SAb+/GAg + patients, SAb-/GAg + patients presented with higher levels of albumin, lower levels of cholesterol and low density lipoprotein cholesterol (all p < .01), but similar pathological manifestations of kidney biopsy. Multivariate logistic analyses indicated that low albumin (0.79 [95%CI: 0.66-0.95], p = .01) and high cholesterol (1.81 [95%CI: 1.02-3.19], p = .04) were correlated with seropositivity of PLA2R antibody. SAb-/GAg + patients exhibited a significantly higher probability of CR (p = .03) than patients who were SAb+/GAg+. However, no difference was found in the PR rate. Cox regression analyses showed that compared to SAb+/GAg + patients, SAb-/GAg + was more predictive of complete remission (4.28 [95%CI: 1.01-18.17], p = .04).
Conclusion: IMN with PLA2R staining on kidney biopsy but without serum PLA2R antibody has milder clinical manifestations and a better prognosis.
期刊介绍：
Renal Failure primarily concentrates on acute renal injury and its consequence, but also addresses advances in the fields of chronic renal failure, hypertension, and renal transplantation. Bringing together both clinical and experimental aspects of renal failure, this publication presents timely, practical information on pathology and pathophysiology of acute renal failure; nephrotoxicity of drugs and other substances; prevention, treatment, and therapy of renal failure; renal failure in association with transplantation, hypertension, and diabetes mellitus.
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