Mr KAIYUAN ZHENG1
1Banan Hospital Of Chongqing Medical University (People’s Hospital Of Chongqing Banan District), Chongqing, China
Biography:
Zheng Kaiyuan, M.D., is an Associate Chief Physician in the Department of Nephrology. Specializing in the diagnosis and treatment of kidney diseases, he possesses extensive clinical experience in managing complex renal conditions. His primary research focus is on the immunopathological and molecular mechanisms underlying membranous nephropathy. Dr. Zheng is dedicated to translating insights from basic science into improved therapeutic strategies for patients. He actively contributes to clinical research and academic discussions within the field of nephrology.
Abstract:
Background: While CD20 monoclonal antibody therapy is a cornerstone treatment for PLA2R-positive membranous nephropathy (MN), patient response is variable.
Aim: This study aimed to evaluate whether the serum anti-PLA2R antibody to total IgG ratio (PATIR) offers superior prognostic value compared to the anti-PLA2R antibody titer alone in predicting treatment response.
Methods: We conducted a retrospective analysis of 121 treatment-naive patients with biopsy-proven PLA2R-positive MN who received standardized rituximab between October 2021 and December 2023. Serum anti-PLA2R antibody and total IgG levels were measured at baseline. Treatment response at 12 months was defined as a ≥50% reduction in 24-hour proteinuria and serum albumin >30 g/L. Binary logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs).
Results: Baseline characteristics were comparable between the 72 responders and 49 non-responders. PATIR was significantly higher in non-responders (0.26±0.08) than responders (0.11±0.02, P<0.001). ROC curve analysis identified an optimal ratio cutoff of 0.19 for predicting non-response, with a sensitivity of 88.5% and specificity of 82.7%. Multivariate analysis confirmed high baseline PATIR as an independent predictor of non-response (OR=3.1, 95% CI: 2.4-4.8). PATIR showed a significantly larger AUC for predicting non-response than antibody titer alone (0.80 vs 0.69, P<0.001).
Conclusion: The baseline PATIR is a powerful and independent predictor of response to CD20 monoclonal antibody therapy in PLA2R-positive MN, outperforming standard anti-PLA2R antibody titer and potentially enhancing early risk stratification.