Introduction

Primary membranous nephropathy (PMN) is a leading cause of nephrotic syndrome in adults. Although proteinuria has been the conventional guiding parameter in disease monitoring, its limitations as a non-specific and delayed marker have led to the appeal of anti-phospholipase A2 receptor antibodies (PLA2R) as specific and sensitive indicators of disease activity and response to treatment.

Methods

This retrospective cohort study included 60 patients with biopsy-proven PMN and positive baseline anti-PLA2R antibodies who underwent treatment at the Multan Institute of Kidney Diseases. Anti-PLA2R levels were measured at baseline and at the 6-month follow-up using enzyme-linked immunosorbent assay (ELISA). Clinical remission was assessed using the standard proteinuria and renal function criteria. Statistical analyses included receiver operating characteristic (ROC) curves, logistic regression, and correlation assessments.

Results

Baseline anti-PLA2R levels were significantly lower in patients who achieved remission (p = 0.047), and 6-month levels showed a strong correlation with treatment response (p < 0.001). ROC analysis demonstrated good predictive accuracy with area under curve (AUC) of 0.707 (baseline) and 0.815 (6-month), identifying optimal remission cutoffs at 125.5 RU/mL and 37.75 RU/mL, respectively. Logistic regression analysis confirmed the baseline albumin level, 6-month anti-PLA2R, and proteinuria reduction as independent predictors of remission.

Conclusion

Anti-PLA2R antibody levels at baseline and 6 months serve as robust predictors of treatment response in PMN and outperform proteinuria in early remission assessment. These findings support the integration of anti-PLA2R monitoring into standard clinical practice for personalized management and therapy adjustment in PMN.