Antiphospholipase A2 Receptor Autoantibody Guided Diagnosis and Treatment of Membranous Nephropathy

Glassock, Richard J.

doi:10.2215/cjn.05880614

Cited by 28 publications

(20 citation statements)

References 18 publications

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“…There is considerable evidence showing that anti-PLA 2 R antibodies correlate with disease activity, provide prognostic information about severity of disease, and can serve as a useful biomarker for assessing treatment efficacy [16].…”

Section: Anti-pla 2 R Antibodies As a Marker For Prognosis And Responmentioning

confidence: 99%

Membranous Nephropathy: Approaches to Treatment

Bomback

Fervenza

2018

Am J Nephrol

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Background: Membranous nephropathy (MN) is a common cause of nephrotic syndrome in adults. This review focuses on mechanisms involved in the pathogenesis of MN and approaches to treatment of this disease. Summary: Our understanding of the pathogenesis of primary MN has advanced greatly with the identification of M-type phospholipase A₂ receptor and thrombospondin type-1 domain-containing 7A as target antigens whose antibodies serve as biomarkers of this disease. Additional research, including investigations into the roles of complement and melanocortin receptors on the podocyte, may further improve our understanding of how best to treat this condition. Immunosuppressive therapies, including corticosteroids alternating with alkylating agents, and calcineurin inhibitors are partially successful in reducing proteinuria in MN, but their use may be associated with significant adverse effects and a high relapse rate. Novel interventions, including targeting B cells with rituximab as well as treatment with adrenocorticotropic hormone (ACTH), are being investigated. Key Messages: The understanding of treatment targets and availability of new biomarkers has facilitated diagnosis and improved risk stratification for MN and may also be useful for individualizing treatment with a wider range of therapeutic options for patients with MN. Considerable evidence supports the use of B-cell depletion as initial therapy in nephrotic patients with MN. ACTH should be considered for patients who do not respond to traditional therapies such as alkylating agents and calcineurin inhibitors.

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Section: Anti-pla 2 R Antibodies As a Marker For Prognosis And Responmentioning

confidence: 99%

Membranous Nephropathy: Approaches to Treatment

Bomback

Fervenza

2018

Am J Nephrol

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“…Recent advancements occurred in therapeutic decision making for diagnosis of glomerular diseases like AntiPLA2 receptor antibodies in serum and in renal tissue. The management 1,2,3,4,5 revolves around it, along with strong association with the HLA DQA1 Allele has been found in pts with idiopathic membranous nephropathy. Similarly the MEST-C score in IGA nephropathy 6,7,8 guided the prognosis and the aggressiveness to the approach regarding management.…”

Section: Introductionmentioning

confidence: 99%

Glomerular Diseases in Madina Region;

Manzoor

Bhatt

Javed

2019

TPMJ

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Objectives: The study is designed to get useful information and epidemiological data for clinical practice and investigations regarding glomerular disease frequencies in Madina region. Study Design & Setting: Single-center retrospective study at King Fahd Hospital Madina. Period: 01 year (March 2016- March 2017). Methods: All native renal biopsies were studied for the period of 1 year (March 2016- March 2017). Only glomerular disease patterns were analyzed. The diagnosis of each case was based on histological, immunopathological and clinical features. Results: A total of 44 biopsies were Included. Primary glomerular diseases in 52.27% of all biopsies studied. The most common primary disease was Membranous Nephropathy which accounts for 20.45%. Focal and Segmental Glomerulosclerosis (FSGS) (9%), Minimal change disease (4.54%), C3 glomerulopathy (4.54%), IGA Nephropathy (4.54%), Non-IgA Mesangial Proliferative GN(2.27%), Crescentic Glomerulonephritis (GN) (2.27%), Post lnfectlous GN(2.27%), Thin Basement Membrane Nephropathy(2.27%) as primary GN. Secondary glomerular diseases in 47.73%. Lupus Nephritis corresponded to 34.09% of the entire series. Conclusions: FSGS has been the most frequent type of glomerulopathy in Saudi Arabian population according to previously available data from local studies but in our study the cases of Membranous Nephropathy were high .Lupus Nephritis remain above the list as a cause of secondary glomerular disease. The reasons for these findings are unclear but this information is an important contribution towards understanding the prevalence of renal diseases In Saudi Arabia.

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“…8 In this article, we will explore how the discovery of the target podocyte antigens and the development of commercial assays for PLA2R and THSD7A Abs may guide diagnosis and management and complement traditional algorithms. 9 The following questions will be addressed. (1) Can PLA2R and THSD7A Abs be used to diagnose MN and thereby, avoid the need for a kidney biopsy?…”

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confidence: 99%

A Proposal for a Serology-Based Approach to Membranous Nephropathy

Vriese

Glassock

Nath

et al. 2016

JASN

Self Cite

292

278

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Primary membranous nephropathy (MN) is an autoimmune disease mainly caused by autoantibodies against the recently discovered podocyte antigens: the M-type phospholipase A2 receptor 1 (PLA2R) and thrombospondin type 1 domain-containing 7A (THSD7A). Assays for quantitative assessment of anti-PLA2R antibodies are commercially available, but a semiquantitative test to detect anti-THSD7A antibodies has been only recently developed. The presence or absence of anti-PLA2R and anti-THSD7A antibodies adds important information to clinical and immunopathologic data in discriminating between primary and secondary MN. Levels of anti-PLA2R antibodies and possibly, anti-THSD7A antibodies tightly correlate with disease activity. Low baseline and decreasing anti-PLA2R antibody levels strongly predict spontaneous remission, thus favoring conservative therapy. Conversely, high baseline or increasing anti-PLA2R antibody levels associate with nephrotic syndrome and progressive loss of kidney function, thereby encouraging prompt initiation of immunosuppressive therapy. Serum anti-PLA2R antibody profiles reliably predict response to therapy, and levels at completion of therapy may forecast long-term outcome. Re-emergence of or increase in antibody titers precedes a clinical relapse. Persistence or reappearance of anti-PLA2R antibodies after kidney transplant predicts development of recurrent disease. We propose that an individualized serology-based approach to MN, used to complement and refine the traditional proteinuria-driven approach, will improve the outcome in this disease.

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Antiphospholipase A2 Receptor Autoantibody Guided Diagnosis and Treatment of Membranous Nephropathy

Cited by 28 publications

References 18 publications

Membranous Nephropathy: Approaches to Treatment

Membranous Nephropathy: Approaches to Treatment

Glomerular Diseases in Madina Region;

A Proposal for a Serology-Based Approach to Membranous Nephropathy

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