The Value of Peripheral Blood Cell Ratios in Primary Membranous Nephropathy: A Single Center Retrospective Study

Abstract

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: χ²=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: χ²=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

Data Sharing Statement

The datasets used during the current study are available from Wen-hu Liu on reasonable request.

Statement of Ethics

This study protocol was reviewed and approved by Ethics Committee of Beijing Friendship Hospital, approval number 2021-P2-269-01, and Ethics Committee of Beijing Friendship Hospital waived the need for informed consent based on the following reasons: (1) the purpose of the study was important; (2) the possible risk to patients was not higher than the minimum one; (3) the waiver of informed consent would not adversely affect the rights and health of patients. (4) the patients’ privacy and personal identity information were well protected. The protocol of the study is compliant with the Declaration of Helsinki.

Acknowledgments

We thank Experimental Center of Beijing Friendship Hospital for their experimental platform support.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare no conflicts of interest in this work.

Additional information

Funding

The authors did not receive any funding.