OBSERVATIONAL ANALYSIS OF TREATMENT OUTCOMES AND ASSOCIATION OF PLA2R LEVELS IN PRIMARY MEMBRANOUS NEPHROPATHY IN A TERTIARY CARE CENTER OF EASTERN INDIA

Introduction:

Membranous nephropathy(MN)is a common cause of nephrotic syndrome (around 25%) in adults across the world. The natural course is variable with approximately 1/3rd of patients achieving spontaneous remission while those with persisting proteinuria progress to ESRD within 10 years. While gold standard for the diagnosis is kidney biopsy,for decision to initiate immunosuppression(IS),quantitative antibody level against PLA2R is an alternative noninvasive technique and the associated risks of a biopsy can be avoided. However PLA2R positivity is not unambiguously correlated with prognosis and decision for IS initiation needs more input from clinical researchers.

In our study we measured PLA2R levels at the baseline in different risk categories of MN and then again measured it serially after treatment completion and tried to find a relation between PLA2R levels and treatment outcomes.

Methods:

It was an observational study in a single center at IPGME&R and SSKMH Kolkata where two groups of primary membranous nephropathy patients were compared as per their treatment outcomes and PLA2R levels. All such patients who were under the follow up of Nephrology department of the institute were included as per the inclusion criteria of the study. The patients were divided into PLA2R positive and negative groups as per their baseline PLA2R levels and analyzed based on the treatment they received. All the patients received conservative treatment with antiproteinuric for minimum duration of 6 months and after that received IS - either Modified Ponticelli(MP),rituximab or tacrolimus on top of standard of care conservative treatment targeted to optimal BP control and tolerability.The baseline characteristics were recorded and reanalyzed at 6 and 12 months after initiation of every treatment.

Results:

The number of patients in the age group of 31-50 were highest in the study. The M:F ratio was around 3:1. 95 patients were PLA2R positive at the baseline(74.8%). 40.6% of PLA2R negative patients required no IS while only 22.1% PLA2R positive patients continued without IS. The highest mean 24 hour urine protein and creatinine levels at baseline were seen in MP group and baseline albumin levels were lowest in MP group. After 6 months of treatment the PLA2R negative patients became 68.5%. 68.8% patients achieved remission(CR+PR) across the PLA2R negative groups at 6 months while 63.1% in PLA2R positive groups.87 patients who completed 1 year of different treatments, 47 (54%) were in remission at 1 year while 7 achieved remission after change in their treatment. At 1 year, 54.1% maintained remission in PLA2R negative groups while 53.9% maintained remission in PLA2R positive group in same duration. Highest number of major and minor adverse events were seen in MP group followed by rituximab group.

Conclusions:

74.8% study population were PLA2R positive at the baseline. 40.6% of PLA2R negative patients required no IS while only 22.1% PLA2R positive patients could continue without IS. After 6 months of treatment the PLA2R levels became negative in 68.5% across all the groups which was 73.7% at one year. Comparable number of patients achieved and maintained remission in both arms at 6 months and 1 year. Overall, serological remission preceded the proteinuric remission. A long term follow up of will help us to know the persistence of remission and other outcomes in this population

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.