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Anti‐Phospholipase A 2 Receptor Antibodies in Recurrent Membranous Nephropathy
Author(s) -
Kattah A.,
Ayalon R.,
Beck L. H.,
Sethi S.,
Sandor D. G.,
Cosio F. G.,
Gandhi M. J.,
Lorenz E. C.,
Salant D. J.,
Fervenza F. C.
Publication year - 2015
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.13133
Subject(s) - medicine , proteinuria , antibody , membranous nephropathy , gastroenterology , immunosuppression , predictive value , persistence (discontinuity) , renal biopsy , immunology , biopsy , kidney , geotechnical engineering , engineering
About 70% of patients with primary membranous nephropathy (MN) have circulating anti‐phospholipase A 2 receptor (PLA 2 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 2 R are at increased risk of recurrence as compared to seronegative patients and to determine if post‐Tx changes in anti‐PLA 2 R correspond to the clinical course. In the recurrent group, 10/17 patients had anti‐PLA 2 R at the time of Tx versus 2/7 patients in the nonrecurrent group. The positive predictive value of pre‐Tx anti‐PLA 2 R for recurrence was 83%, while the negative predictive value was 42%. Persistence or reappearance of post‐Tx anti‐PLA 2 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 2 R and biopsy evidence of recurrence in which the antibodies resolved with standard immunosuppression. Some cases with positive pre‐Tx anti‐PLA 2 R were seronegative at the time of recurrence. In conclusion, patients with positive pre‐Tx anti‐PLA 2 R should be monitored closely for recurrent MN. Persistence or reappearance of antibody post‐Tx may indicate a more resistant disease.