Membranous nephropathy (MN) is a relatively common glomerular disease. Recent advances point to PLA2 antibodies playing a role in its pathophysiology. There were a few abstracts at this year’s WTC aimed to better understand recurrent MN and the role of PLA2 antibodies. Here are the highlights:

1. MN was found to reoccur in 47% of patients (demonstrated with protocol biopsies) and usually occurred within the first 6 months post-transplant.
2. In 45% of recurrences proteinuria was low grade (<1 gm).
3. In 21% of the time proteinuria exceeded 1 gm.
4. 45% of recurrences had no clinical progression and did not require treatment.
5. 81% of patients with recurrence who were treated with rituximab had a complete or partial remission.
6. Overall graft survival was the same in patients with recurrence vs. those without recurrence.
7. Recurrence was more common in patients with high grade proteinuria.
8. In one study high pre-transplant PLA2 antibody predicted recurrence with a PPV of 80 and NPV of 88%.

In summary MN recurs frequently post-transplant but can be treated with rituximab and usually does not cause premature graft loss. In addition there appears to be a role of PLA2 antibodies identifying patients at risk for recurrence although more data is needed before we consider routine testing.

Post written by Dr. Vinay Nair, eAJKD Advisory Board member.

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