Background: Primary membranous nephropathy (PMN) is a common cause of nephrotic syndrome in adults. Forty percent of the patients continue to progress and eventually develop into chronic renal failure. Although phospholipase A2 receptor (PLA2R) is the major antigen of PMN, the clinical features do not often parallel with the antibody titers. Therefore, it is significant to find relative credible markers to predict the treatment response.
Methods: One hundred and eighteen PMN patients were recruited. The response to treatment was defined as ALB≥ 30g/L at 6 months and complete remission (CR) or not at the end of the follow-up. Renal outcome endpoint was defined as 50% or more Cr increase at the end.
Results: The patients with poor treatment effects had numerically higher platelet-lymphocytes ratio (PLR). For patients with CR or not, the difference was near to statistic significant (P =0.095). When analyzing CR or not, the fitting of the binary logistic regression model including both PLA2R Ab titer and PLR (Hosmer–Lemeshow test: χ ²=8.328, P = 0.402; OR (PLA2R Ab titer) = 1.002 (95% CI 1.000– 1.004, P = 0.042); OR (PLR) = 1.006 (95% CI 0.999– 1.013, P = 0.098)) was markedly better than that with only PLA2R Ab titer (Hosmer–Lemeshow test: χ ²=13.885, P = 0.016). The patients with renal function deterioration showed significantly higher monocyte-lymphocyte ratio (MLR) (0.26 (0.22– 0.31) vs 0.18 (0.13– 0.22), P = 0.012).
Conclusion: PMN patients with poor treatment response tended to have higher PLR at the time of renal biopsy, and a higher MLR was associated with poor renal outcomes. Our findings suggested that PLR and MLR might be used to predict treatment efficacy and prognosis for PMN patients, respectively.
Keywords: membranous nephropathy, peripheral blood cell ratios, platelet-lymphocytes ratio, monocyte–lymphocyte ratio, treatment response, outcome