Table 2.
Nephrin Antibody Findings and Post-Transplant Clinical Outcomes in Recipients With Diffuse Podocytopathy
| First Author (Y) | Serum Nephrin Ab | Timing of Nephrin Ab | Detection Method | Pre-TX Ab Depletion | Recurrence (n, %) | Recurrence Timing | Treatment | Allograft Failure | Clinical Course | Follow-up Duration |
|---|---|---|---|---|---|---|---|---|---|---|
| Shirai, et al12 (2024) | 11/11 (100%); median 899 (831-1,292 U/mL) | Before TX or during recurrence (within 1 day post-TX) | ELISA with cutoff 231 U/mL against mouse myeloma cell (NS0)-derived extracellular domain of recombinant human nephrin (R&D) | 4/11 (36%) PLEX only; 3/11 (27%) PLEX+RTX | 11/14 (79%) among nongenetic FSGS | Immediate/early within 1 day | PLEX 9 (82%) ± rituximab 3 (27%) | 2 (18%) | Anti-nephrin levels fell to 155 (53-367) U/mL in 5 with remission. 1 achieved spontaneous remission; another responded to pMP | NR |
| 1/3 (33%); median 165 (153-244) | 3/3 (100%) received PLEX+RTX | NR | NR | NR | NR | NR | ||||
| Negative | 3/8 (38%) PLEX | None | NR | NR | None | NR | NR | |||
| Batal, et al4 (2024) | 8/38 (21%) | Pre-TX | ELISA with cutpoint >187 U/mL against extracellular domain of recombinant human nephrin (hNephrinG1059) | 21 (4 PLEX+RTX, 17 PLEX only) | 22/39 (56%) recurred; 8/21 (38%) of them were anti-nephrin positive, whereas none of the nonrecurrent cases were positive | 8 (6-20) days in nephrin Ab positive; 20 (9-39) days in nephrin Ab negative | PLEX alone 2 (9%) PLEX + IVIG (± others) 7 (32%) PLEX + rituximab (± others) 3 (14%) PLEX + obinutuzumab (± others) 3 (14%) PLEX + CsA (± others) 7 (32%) Multi-drug (PLEX + ≥3 agents) 5 (23%) |
12 (31%); 10 due to recurrent DP, 2 due to rejection (time to graft failure 30 (13-48) months) | Four died with functioning graft | 43 (8-79) mo |
| 3/30 (10%) | 15 (3 PLEX+RTX, 12 PLEX only) | 15 of 30 in FSGS | 7 (23%); 5 due to recurrent DP, 2 due to rejection | Three died with functioning graft | ||||||
| 3/7 (43%) | 4 (1 PLEX+RTX, 3 PLEX only) | 5 of 7 in MCD | 3 (43%) due to recurrence | One died with functioning graft | ||||||
| Habbig, et al11 (2025) | Positive at 100-200 RU/mL before RTX and PLEX | Before and after TX | ELISA, WB, and immunoprecipitation using R&D mouse and human, and SinoBio human cells | RTX + PLEX | No | NR | NR | No | Immediate graft function after nephrin Ab cleared | Over 1 y |
| Miyazaki, et al16 (2025) | Positive at 1,645 and 517 U/mL (cutoff >226), before and after LDL apheresis, respectively | 9 years post-TX | NR | NR | Yes; biopsy-confirmed MCD | Three and 9 years post-TX | LDL-C apheresis then switched to pMP + single RTX | No | Refractory to LDL-C apheresis × 4 courses. Quickly responded to pMP + single RTX; nephrin Ab became undetectable and proteinuria resolved | 188 d |
Note: Values for age are median (IQR) in years unless otherwise noted.
Abbreviations: Ab, antibody; CsA, cyclosporine A; DP, diffuse podocytopathy; ELISA, enzyme-linked immunosorbent assay; FSGS, focal segmental glomerulosclerosis; IVIG, intravenous immunoglobulin; LDL-C, low-density lipoprotein cholesterol; MCD, minimal change disease; MMF, mycophenolate mofetil; PLEX, plasma exchange; pMP, pulse methylprednisolone; RTX, rituximab; TX, transplantation; Tac, tacrolimus; WB, Western blot; NR, not reported.