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MP201CLINICAL CHARACTERISTICS AND PROGNOSIS OF PATIENTS WITH PRIMARY MEMBRANOUS NEPHROPATHY REGARDING PRESENCE OF ANTI PLA2R ANTIBODIES - A CROATIAN MULTICENTER STUDY

INTRODUCTION AND AIMS: As natural course of iMN varies it is important to determine clinical and laboratory parameters reliable for prediction of clinical outcome and decision on immunosuppressive treatment. Antibodies against M-type phospolipase A2 receptor ( anti PLA2R) are considered highly specific for iMN. In this first Croatian multicenter retrospective study we evaluate the clinical course and prognosis of patients with iMN regarding anti PLA2R status. METHODS: We included 32 consecutive patients (21 M, 11 F) between 8/2014 and 6/2016, median age 55 (20-81) years with biopsy proven iMN and follow-up of at least 6 months. Anthropometric characteristics, blood pressure (BP), hemoglobin (Hb), serum creatinine (sCr), eGFR, 24 proteinuria, serum albumine (sAlb) and atiPLA2R levels (ELISA) were determined in all patients at the time of renal biopsy and during follow-up. All patients were treated with combinations of corticosteroids, cyclophosphamide, cyclosporine and mycophenolate mophetil according to KDIGO guidelines. We defined complete remission as persistent proteinuria < 0.3 g/du and normal serum creatinine (cCr) and partial remission as persistent proteinuria < 3.5 g/du and decrease > 50% from baseline with stable sCr. RESULTS: 19 patients had positive antiPLA2R (> 20 RU/ml) (59, 3%), median 97 ( 21-1418 ) RU/ml. There were no significant differences in basal values of BP, Hb, sCr, eGFR, proteinuria and sAlb between antiPLA2R positive and negative group as well as according to gender. Median follow- up was 18 (range 6-84) months. When we analyse patients regarding lower (< 200 RU/ml) and higher levels (>200 RU/ml) of antiPLAR significant difeference in remision rate was observed (90 vs 50%, χ2 4.0, p=0.045). Highest antiPLA2R values were found in group without remission (88 vs 265 RU/ml p=0.093). Significant positive correlations were found between antiPLA2R levels and sCr (r=0.401 p=0.023) and proteinuria (r=0.493, p=0.004). Multiple regression analysis indicate basal sCr (ß=0.682, p<0.001) and antiPLA2R (ß=0.527, p<0.001) as key determinants of renal function at the end of follow-up and antiPLA2R levels as key determinant of proteinuria (ß=0.544, p=0.002). CONCLUSIONS: Higher levels of antiPLA2R were associated with worse renal function and proteinuria in patients with iMN. Assesment of antiPLA2R could be reliable tool for guidance of theraputic plan.

membranous glomerulonephritisantibodiescroatian

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