Anti-PLA2R antibody levels and clinical risk factors for predicting relapse in primary membranous nephropathy
In brief
Persistent PLA2R antibodies at 3 months marked nearly ninefold relapse risk
In this single-center study, 17 of 96 patients who reached remission relapsed. Among patients assessed at 3 months, those still positive for anti-PLA2R antibodies had nearly nine times the subsequent relapse hazard; a larger rise in albumin was linked to lower risk. These exploratory findings need validation before guiding care.
- Journal
- Frontiers in immunology (Q1)
- Published
- 25 September 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Hongju Wang, Huijuan Ma, Huijing Wang
- PMID
- 42856680
- DOI
- 10.3389/fimmu.2026.1780071
Why clinicians should know about it
- Picked for Nephrology (paper of the day, 14 October 2026): Anti‑PLA2R antibodies predict relapse in membranous nephropathy
Abstract
OBJECTIVES: To explore the predictive value of anti-phospholipase A2 receptor (PLA2R) antibody levels and clinical risk factors for relapse in patients with primary membranous nephropathy (pMN) who achieved remission after immunosuppressive therapy. METHODS: This study was a single-center, retrospective, cohort study. Patients with biopsy-proven pMN from Jining No.1 People's Hospital, who had a follow-up period of at least 12 months, were enrolled. Three landmark time points were evaluated: baseline and 3 and 6 months after treatment initiation. Multivariable Cox regression, receiver operating characteristic curve analysis, and Kaplan-Meier survival analysis were performed. Cox model discrimination and fit were assessed using Harrell's C-index and the Akaike information criterion (AIC), respectively. RESULTS: A total of 154 patients with PLA2R-associated pMN were included in the study. Among the 96 patients (62.34%) who achieved remission (either partial or complete) within 12 months, 17 (17.71%) experienced a relapse; the median time from treatment initiation to relapse was 23 months. The baseline anti-PLA2R antibody level in the relapse group was significantly higher than that in the non-relapse group (p < 0.001). In the 3-month landmark model, anti-PLA2R antibody seropositivity at 3 months (≥ 14 RU/mL) was independently associated with a higher subsequent risk of relapse (HR 9.44, 95% CI 2.69-33.21; p < 0.001), whereas a greater increase in serum albumin from baseline to 3 months was associated with a lower relapse risk (HR 0.85, 95% CI 0.74-0.98; p = 0.03). The 3-month landmark model demonstrated better model fit and discrimination than the 6-month landmark model, with a lower AIC (123.41 vs. 138.84) and a higher C-index (0.83 vs. 0.66). CONCLUSION: In this exploratory study, anti-PLA2R antibody seropositivity and a blunted increase in serum albumin after 3 months of treatment were identified as potential risk factors for relapse among patients with pMN who achieved remission. Larger-scale studies are warranted for further validation.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.