Anti-phospholipase A<inf>2</inf> receptor antibodies in recurrent membranous nephropathy

A. Kattah, R. Ayalon, L. H. Beck, Sanjeev M Sethi, D. G. Sandor, Fernando G Cosio, M. J. Gandhi, E. C. Lorenz, D. J. Salant, Fernando Custodio Fervenza

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Abstract

About 70% of patients with primary membranous nephropathy (MN) have circulating anti-phospholipase A<inf>2</inf> receptor (PLA<inf>2</inf>R) antibodies that correlate with disease activity, but their predictive value in post-transplant (Tx) recurrent MN is uncertain. We evaluated 26 patients, 18 with recurrent MN and 8 without recurrence, with serial post-Tx serum samples and renal biopsies to determine if patients with pre-Tx anti-PLA<inf>2</inf>R are at increased risk of recurrence as compared to seronegative patients and to determine if post-Tx changes in anti-PLA<inf>2</inf>R correspond to the clinical course. In the recurrent group, 10/17 patients had anti-PLA<inf>2</inf>R at the time of Tx versus 2/7 patients in the nonrecurrent group. The positive predictive value of pre-Tx anti-PLA<inf>2</inf>R for recurrence was 83%, while the negative predictive value was 42%. Persistence or reappearance of post-Tx anti-PLA<inf>2</inf>R was associated with increasing proteinuria and resistant disease in 6/18 cases; little or no proteinuria occurred in cases with pre-Tx anti-PLA<inf>2</inf>R and biopsy evidence of recurrence in which the antibodies resolved with standard immunosuppression. Some cases with positive pre-Tx anti-PLA<inf>2</inf>R were seronegative at the time of recurrence. In conclusion, patients with positive pre-Tx anti-PLA<inf>2</inf>R should be monitored closely for recurrent MN. Persistence or reappearance of antibody post-Tx may indicate a more resistant disease.

Original languageEnglish (US)
Pages (from-to)1349-1359
Number of pages11
JournalAmerican Journal of Transplantation
Volume15
Issue number5
DOIs
StatePublished - May 1 2015

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Keywords

  • Clinical research
  • glomerular biology and disease
  • kidney transplantation
  • nephrology
  • practice
  • recurrent disease

ASJC Scopus subject areas

  • Transplantation
  • Immunology and Allergy
  • Pharmacology (medical)

Cite this

Kattah, A., Ayalon, R., Beck, L. H., Sethi, S. M., Sandor, D. G., Cosio, F. G., Gandhi, M. J., Lorenz, E. C., Salant, D. J., & Fervenza, F. C. (2015). Anti-phospholipase A<inf>2</inf> receptor antibodies in recurrent membranous nephropathy. American Journal of Transplantation, 15(5), 1349-1359. https://doi.org/10.1111/ajt.13133