摘要
Background： According to the renal phospholipase A2 receptor （PLA2R） immunohistochemistry, idiopathic membranous nephropathy （iMN） could be categorized into PLA2R-associated and non-PLA2R-associated iMN. This study aimed to examine whether the non-PLA2R-associated iMN had any difference in clinical features compared with PLA2R-associated iMN. Methods： A total of 231 adult patients diagnosed as iMN were recruited to this retrospective study. Renal PLA2R expression was examined by immunofluorescence. Among these patients, 186 （80.5%） with complete baseline clinical data were used for further study. Urinary protein excretion, serum albumin, and creatinine were analyzed. For those patients with follow-up longer than 1 year, the relationship between PLA2R and response to immunosuppressants were analyzed. The t-test was used for parametric analysis and the Mann-Whitney U-test was used for nonparametric analysis. Categorical variables were described as frequencies or percentages, and the data were analyzed with Pearson＇s Chi-squaxe test or Fisher＇s exact test. Results： Of the 231 iMN patients, 189 showed renal detectable PLA2R expression （81.8%）. The baseline serum creatinine, serum albumin, and urine protein excretion were not significantly different between PLA2R-associated （n = 145） and non-PLA2R-associated iMN patients （n = 41）. However, about 1/3 of the non-PLA2R-associated iMN had abnormal serological tests, significantly more common than PLA2R-associated iMN （31.7% vs. 8.3%, P = 0.000）. The non-PLA2R-associated iMN had lower C4 levels compared with PLA2R-associated iMN （P = 0.004）. The non-PLA2R-associated iMN patients also showed a better response to immunosuppressants （complete remission [CR] 42.9%; partial remission [PR] 14.3%） compared with PLA2R-associated iMN （CR 3.2%; PR 48.4%, P = 0.004） at the 3rd month. Conclusions： There were no significant differences in serum creatinine, albumin, and urine protein excretion between PLA2R-associated and non-PLA2R-associated iMN, while the non-PLA2R-associated iMN patients showed more abnormal serological tests. The non-PLA2R-associated iMN seemed to respond more quickly to the immunosuppressive therapy compared with P LA2R-associated iMN.
Background： According to the renal phospholipase A2 receptor （PLA2R） immunohistochemistry, idiopathic membranous nephropathy （iMN） could be categorized into PLA2R-associated and non-PLA2R-associated iMN. This study aimed to examine whether the non-PLA2R-associated iMN had any difference in clinical features compared with PLA2R-associated iMN. Methods： A total of 231 adult patients diagnosed as iMN were recruited to this retrospective study. Renal PLA2R expression was examined by immunofluorescence. Among these patients, 186 （80.5%） with complete baseline clinical data were used for further study. Urinary protein excretion, serum albumin, and creatinine were analyzed. For those patients with follow-up longer than 1 year, the relationship between PLA2R and response to immunosuppressants were analyzed. The t-test was used for parametric analysis and the Mann-Whitney U-test was used for nonparametric analysis. Categorical variables were described as frequencies or percentages, and the data were analyzed with Pearson＇s Chi-squaxe test or Fisher＇s exact test. Results： Of the 231 iMN patients, 189 showed renal detectable PLA2R expression （81.8%）. The baseline serum creatinine, serum albumin, and urine protein excretion were not significantly different between PLA2R-associated （n = 145） and non-PLA2R-associated iMN patients （n = 41）. However, about 1/3 of the non-PLA2R-associated iMN had abnormal serological tests, significantly more common than PLA2R-associated iMN （31.7% vs. 8.3%, P = 0.000）. The non-PLA2R-associated iMN had lower C4 levels compared with PLA2R-associated iMN （P = 0.004）. The non-PLA2R-associated iMN patients also showed a better response to immunosuppressants （complete remission [CR] 42.9%; partial remission [PR] 14.3%） compared with PLA2R-associated iMN （CR 3.2%; PR 48.4%, P = 0.004） at the 3rd month. Conclusions： There were no significant differences in serum creatinine, albumin, and urine protein excretion between PLA2R-associated and non-PLA2R-associated iMN, while the non-PLA2R-associated iMN patients showed more abnormal serological tests. The non-PLA2R-associated iMN seemed to respond more quickly to the immunosuppressive therapy compared with P LA2R-associated iMN.
