ArticleScientific reports2026
Early kinetics of anti-PLA2R-IgG4 predicts rituximab response in membranous nephropathy: a prospective biomarker study.
Article in Scientific reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
While anti-PLA2R-IgG4 is a key biomarker in idiopathic membranous nephropathy (IMN), the predictive value of its early kinetics for rituximab (RTX) response is unclear. This prospective study enrolled 60 biopsy-proven IMN patients receiving RTX monotherapy. Serum anti-PLA2R-IgG and IgG4 were measured serially via time-resolved fluorescence immunoassay (TRFIA) over 12 months. The primary endpoint was clinical remission at 12 months. A rapid early decline in anti-PLA2R-IgG4 was the strongest predictor of remission. Patients achieving a ≥ 50% reduction in anti-PLA2R-IgG4 by month 1 (Rapid Decliners) had a significantly shorter median time to remission and a 4.91-fold higher likelihood of achieving remission compared to Slow Decliners. In contrast, early declines in total anti-PLA2R-IgG were not predictive. Multivariate analysis confirmed that the percentage decline in IgG4 at months 1, 2, and 4 were independent predictors of remission, with the model at month 4 showing the highest discriminative ability. When these kinetic indicators were included, baseline IgG4 level lost its independent predictive significance. The early kinetics of anti-PLA2R-IgG4 effectively predict the response to rituximab in membranous nephropathy, outperforming both baseline anti-PLA2R-IgG4 levels and total anti-PLA2R-IgG dynamics. Kewords. Anti-PLA2R-IgG4. Membranous nephropathy. Nephrotic syndrome. Prediction. Rituximab.
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