The clinical outcome and risk factors of phospholipase A2 receptor-associated idiopathic membranous nephropathy in adults
10.3760/cma.j.issn.1001-7097.2019.01.001
- VernacularTitle:成人磷脂酶A2受体相关特发性膜性肾病的自然病程和治疗反应的影响因素
- Author:
Ruiying CHEN
1
;
Jianda LU
;
Qionghong XIE
;
Shaojun LIU
;
Ping CHENG
;
Min ZHANG
;
Lingyun LAI
;
Jun XUE
;
Chuanming HAO
Author Information
1. 复旦大学附属华山医院肾病科
- Keywords:
Glomerulonephritis;
membranous;
Receptors;
phospholipase A2;
Immunosuppression;
Prognosis;
Idiopathic membranous nephropathy
- From:
Chinese Journal of Nephrology
2019;35(1):1-8
- CountryChina
- Language:Chinese
-
Abstract:
Objective To report the spontaneous remission and induced remission of phospholipase A2 receptor (PLA2R)-associated idiopathic membranous nephropathy (IMN) in adults,as well as to explore the potential prognostic factors.Methods A total of 120 patients with IMN in Huashan Hospital during 2012 and 2017 were enrolled and their clinical data were collected.Results PLA2R-associated IMN patients accounted for 89.2％ of the IMN patients.Spontaneous remission occurred in 35.5％ of PLA2R-associated IMN patients.The patients with higher serum albumin and lower level of PLA2R antibody were more likely to achieve spontaneous remission (both P ＜ 0.05).Multivariate logistic regression analysis showed that male was an independent risk factor for spontaneous remission in PLA2R-associated IMN patients (OR=0.060,95％CI 0.007-0.493,P=0.009),while higher serum albumin at baseline (OR=1.480,95％ CI 1.144-1.932,P=0.004) and the improvement of serum albumin after 3 months' non-immunosuppressive treatment (OR=2.040,95％CI 1.322-3.151,P=0.001) were independent protective factors for spontaneous remission.About 42.1％ PLA2R-associated IMN patients had received immunosuppressive therapy,with induced remission rate being 70.7％.High serum albumin before treatment was an independent protective factor for induced remission (OR=1.268,95％ CI 1.014-1.585,P=0.038).Conclusions PLA2R-associated IMN accounts for most of the IMN patients,with a spontaneous remission rate of 35.5％,during the follow-up period,which is even higher in patients with higher baseline serum albumin and lower PLA2R antibody titer.Induced remission rate is 70.7％ in patients in need of immunosuppresants.The serum albumin level may be helpful in predicting spontaneous remission and response to immunosuppressive therapy.
