Background: The complement factor H (CFH) regulates activation of the alternative complement pathway. Autoantibodies against CFH are involved in progressive renal dysfunction in cases with primary membranous nephropathy (MN). However, the prevalence and roles of anti-CFH antibodies in the clinical outcome of MN patients remain unclear.Methods: We retrospectively investigated data of 36 Japanese patients with primary MN (23 men, 13 women; mean age: 64.5 [59-72] years) and 18 healthy normal

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... ls (8 men, 10 women; mean age: 31 [27-38] years). Serum anti-CFH antibody titers were measured by enzyme-linked immunosorbent assay.Results: Anti-CFH antibody titers were significantly higher in MN patients than in normal controls (4.69 [3.69-6.38] AU/mL vs. 0 [0-0] AU/mL, p<0.001). The patients were divided into groups: anti-CFH antibody positive group (n=28) and anti-CFH antibody negative group (n=8). No significant difference was observed in the remission rate of proteinuria and the incidence of 30% reduction of estimated glomerular filtration rate (eGFR) or 50% elevation of serum creatinine (Cr) levels between both groups. Anti-CFH antibody titer was selected as an independent unfavorable predictor of renal dysfunction by Cox proportional hazards analysis adjusted by age, gender, serum Cr levels, proteinuria (g/gCr), anti-CFH antibody titer, and immunosuppressive therapy (adjusted hazard ratio (HR) 1.344, 95% confidence intervals (CI) 1.038 to 1.741, p=0.025 for 30% reduction of eGFR; adjusted HR 1.930, 95% CI 1.108 to 3.363, p=0.020 for 50% elevation of serum Cr).Conclusions: These data suggest that anti-CFH antibodies may be involved in the deterioration of renal function in primary MN.