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Background and Aims The predictive value of anti-phospholipase A2 receptor antibody (anti-PLA2R ab) levels at three-months from diagnosis in patients with membranous nephropathy (MN) is not proven. Method We retrospectively examined the renal outcome on 1 August 2020 of 59 adult patients (age 54 (44, 68) years, 69% male, serum creatinine 1.0 (0.9, 1.3) mg/dL) who were diagnosed with MN by kidney biopsy and had positive serum anti-PLA2R ab during 2016-2019. The outcomes were: kidney survival defined as renal replacement therapy (RRT) initiation; partial (proteinuria 0.5 to 3.5g/24h) or complete remission (proteinuria &amp;lt;0.5g/24h and serum albumin ≥3.5g/dL) - whichever came first. Variables related to renal outcome were further evaluated in univariate and multivariate Cox proportional hazard (CPH) models. Results Forty (69%) patients had negative anti-PLA2R ab at 3 months; there were no differences regarding age, serum creatinine, serum albumin, proteinuria and treatment when compared to the group with positive ab at 3 months. Fifty-seven (97%) patients received immunosuppressive treatment, cyclophosphamide-based regimens were the most frequent (87%), followed by cyclosporine (10%). Overall, 64% of the patients reached a form of remission. Cumulative remission rates were 34% after 6 months, 54% after 12 months, 68% after 18 months and 73% after 24 months. Only five patients (9%) relapsed during the study period. Median time to cumulative remission was 12.0 (95%CI 8.2, 15.7) months. In the CPH models, negativization of the anti-PLA2R antibodies at three months was an independent predictor for remission, however lower serum albumin was also retained as a risk factor for absence of remission (Table 1). During the follow up period 6 (10%) patients died. Cardiovascular disease and infections were the main causes of death. A total of 5 (9%) patients started RRT during the study period. The mean renal survival time was 50.3 (95%CI 46.5, 54.0) months. We found no difference in renal survival regarding anti-PLA2R Ab titer or negativization. Conclusion Negativization of anti-PLA2R antibodies in the first three months from diagnosis was a predictor for remission in patients with membranous nephropathy.

MO270PROGNOSTIC ROLE OF ANTI-PHOSPHOLIPASE A2 RECEPTOR ANTIBODY NEGATIVIZATION AT THREE MONTHS IN MEMBRANOUS NEPHROPATHY