The association of serum anti-nephrin antibody with the onset, clinical indicators and prognosis in focal segmental glomerulosclerosis and minimal change nephropathy: systematic review and meta-analysis

Objective: To investigate the correlation between serum anti-nephrin antibody and the onset, clinical indicators and prognosis of patients with focal segmental glomerulosclerosis (FSGS) and minimal change nephropathy (MCD). Methods: Articles published between January 2015 and May 2025 were retrieved from domestic and international databases. Meta-analysis was performed using RevMan 5.3 software. Heterogeneity among studies was assessed through I2 and Q tests. Results: This meta-analysis included 7 studies with 1,489 participants. The results showed significantly higher serum anti-nephrin antibody positivity rates in patients with FSGS (OR=34.39,95% CI=8.14-145.25; P <0.00001) and MCD (OR=50.68,95% CI=15.17-169.32; P <0.00001) compared to healthy controls. Patients with primary FSGS (OR=8.06,95% CI=3.47-18.69; P <0.00001) and MCD (OR=29.95,95% CI=10.51-85.35; P <0.00001) also exhibited significantly higher positivity rates than those with membranous nephropathy. No significant difference was observed in anti-nephrin antibody positivity rates between primary and secondary FSGS patients (OR=4.95,95% CI=0.77-31.64; P=0.09). Serum anti-nephrin antibodies showed significant correlations with 24-hour urinary protein (MD=3.42,95% CI=1.96-4.88; P <0.00001) and creatinine (MD=17.26,95% CI=9.77-24.74; P <0.00001), but no significant correlation was found with serum albumin or estimated glomerular filtration rate (eGFR). Patients with positive serum anti-nephrin antibodies demonstrated significantly higher rates of complete remission followed by relapse compared to those with negative antibodies (OR = 4.17,95% CI = 2.71-6.41, P <0.00001). No significant difference was observed in disease remission rates between the two groups. Post-transplant FSGS relapse group showed markedly higher anti-nephrin antibody positivity rates than the non-relapse group (OR = 25.58,95% CI = 2.38-275.09, P = 0.007). Conclusion: The onset of MCD and primary FSGS is closely associated with serum anti-nephrin antibodies. The expression of this antibody correlates with disease activity and prognosis, particularly in predicting disease recurrence after remission.