The correlation between PLA2R-Ab levels and clinical characteristics of primary membranous nephropathy, and the exploration of its application value in treatment selection

OBJECTIVE: To analyze differences in clinicopathological features of primary membranous nephropathy (PMN) patients based on PLA2R-Ab titers and assess treatment efficacy and adverse reactions. METHODS: According to the different titers of PLA2R antibodies, patients were divided into PLA2R antibody negative group, PLA2R antibody low titer group, and PLA2R Ab high titer group, and inter group data comparison was conducted. Further screen patients who have been regularly followed up for at least 12 months, and divide them into hormone+CTX group, hormone+TAC group, hormone+CsA group, RTX group, and supportive treatment group according to different treatment plans. Compare the treatment efficacy of each treatment group at 3, 6, 9, and 12 months; Meanwhile, compare the efficacy and adverse reactions of the PMN group, PLA2R Ab positive group, and negative group in each treatment group at 1 year. Analyze independent risk factors that affect effective mitigation through multiple factor Cox regression analysis. RESULTS: PLA2R-Ab titers correlated with proteinuria severity and tubulointerstitial damage. The negative group had higher 1-year remission rates than the positive group. Hormone+CTX and hormone+TAC showed superior efficacy at 1 year. Adverse events did not differ significantly between treatments (PLA2R-Ab+: 16.05%; PLA2R-Ab–: 28.30%). Independent risk factors for 1-year remission included baseline PLA2R-Ab positivity, higher 24h proteinuria, and diabetes. CONCLUSION: Serum PLA2R-Ab status was correlated with the severity of proteinuria and the degree of tubulointerstitial damage, and the effective remission rate was higher in PLA2R-Ab-negative status, and baseline PLA2R-Ab positivity, severity of baseline 24-h urine protein quantification, and combined diabetes mellitus could be used as independent risk factors predicting the effective remission rate of patients with PMN within 1 year. Clinical trial number: not applicable.