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To investigate the clinical, pathological and prognostic characteristics of patients with idiopathic membranous nephropathy (IMN) with dual antigen positivity.
We selected patients diagnosed with idiopathic membranous nephropathy with dual antigen positivity through renal tissue pathological examination at our center and retrospectively collected their clinical, pathological, and follow-up data. Serum antibody levels were measured at multiple time points. Additionally, all dual antigen-positive IMN cases reported in the literature were reviewed to extract clinical, pathological, and prognostic information. We compared the data for all of the above dual antigen-positive and PLA2R single-positive IMN cases at our center.
We identified 6 IMN patients with dual antigen positivity at our center; the previous literature reports 43 IMN patients with dual antigen positivity. The IgG1 positivity rate in the renal tissue of the dual antigen-positive patients at our center was significantly lower than that of 43 dual antigen-positive patients previously reported (16.7% vs. 100.0%, p=0.015), but there was no significant difference in clinical or prognostic aspects. Compared with PLA2R single-positive IMN patients, all dual antigen-positive IMN patients had a higher renal tissue IgG1 positivity rate (58.3% vs. 22.3%, p=0.016), and the time required to achieve remission was longer [13.5 (3.3,35.0) vs. 3.0 (1.0,8.0), p=0.052]. Overall, there is good consistency between changes in serum PLA2R antibody levels and changes in the condition in patients with dual antigen-positive IMN.
For patients with poorly treated primary membranous nephropathy, multiple target antigen staining should still be actively performed, even with positivity for the PLA2R target antigen.