Response to immunosuppressive therapy in PLA2R- associated and non-PLA2R- associated idiopathic membranous nephropathy: a retrospective, multicenter cohort study

BMC Nephrology

Research Article

Shaojun Liu¹  Yan Li¹  Jia Wang¹  Qionghong Xie¹  Jun Xue¹  Ningxin Xu¹  Chuan-Ming Hao¹  Liang Wang²  Zhuxing Sun² 

[1] Division of Nephrology, Huashan Hospital, Fudan University, Wulumuqi Rd. (middle), 200040, Shanghai, China;Division of Nephrology, Wuxi People’s Hospital, Qingyang Rd., Wuxi, Jiangsu province, China;

关键词: Calcineurin inhibitors;    Cyclophosphamide;    Idiopathic membranous nephropathy;    M type phospholipase A receptor;    Immunosuppressive therapy;    Remission;   

DOI  :  10.1186/s12882-017-0636-0

 received in 2016-11-30, accepted in 2017-06-26,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundAccording to renal M type phospholipase A2 receptor (PLA2R) immunohistochemistry, idiopathic membranous nephropathy (IMN) could be categorized into PLA2R-associated and non-PLA2R-associated IMN. We conducted a retrospective, multicenter cohort study with 91 patients to compare the effect of immunosuppressive therapy between PLA2R-associated and non-PLA2R-associated IMN patients.MethodsA total of 91 biopsy-proven IMN patients from Huashan hospital and People’s Hospital of Wuxi in past 5 years were collected into this study. IMN with positive PLA2R immunohistochemistry in kidney biopsies were designated as PLA2R-associated IMN. Seventy-eight of the 91 IMN patients was PLA2R-associated IMN and 13 were non-PLA2R-associated IMN. Forty-five patients were treated with prednisone plus cyclophosphamide (CTX), and 46 with prednisone plus calcineurin inhibitors (CNIs). The follow-up duration was 15 months.ResultsThe total remission rate (76.9% versus 44.9%, p = 0.032) and complete remission rate (30.8% versus 2.6%, p = 0.003) were both significantly higher in the non-PLA2R-associated group than in the PLA2R-associated group at the 3rd month visit point, and at the 6th month time point, the complete remission rate was still significantly higher in the non-PLA2R-associated group (46.2% versus 11.5%,p = 0.007). But similar remission rates were found after the 9th month. Relapses were observed in 8 patients in PLA2R-associated group and none in non-PLA2R-associated group, although there was no significant difference between these two groups.ConclusionCompared with the PLA2R-associated IMN, the non-PLA2R-associated IMN responded quicker to the immunosuppressive therapy.

【 授权许可】

CC BY   
© The Author(s). 2017