Combined Assessment of Phospholipase A2 Receptor Autoantibodies and Glomerular Deposits in Membranous Nephropathy

Abstract

Serum phospholipase A2 receptor antibodies (SAbs) and glomerular phospholipase A2 receptor antigen (GAg) deposits have been observed in idiopathic membranous nephropathy (IMN). However, the clinical application of these two biomarkers, particularly GAg deposition, needs to be further evaluated. We measured SAb concentration by ELISA and GAg deposition by immunofluorescence in 572 patients with biopsy-proven IMN. Overall, 68.5% of patients (392 of 572) had detectable SAb (SAb+), and 98.7% of patients who were SAb+ (387 of 392) and 70.6% of patients who were SAb- (127 of 180) had GAg deposition (GAg+). Compared with patients who were SAb-/GAg+, patients who were SAb+/GAg+ exhibited higher levels of proteinuria (P<0.001) and a lower chance of proteinuria remission (P<0.001). In 52 patients who underwent repeat biopsies, patients who did not achieve remission had a higher SAb+ rate on the first biopsy than patients who went into remission (P=0.001). Furthermore, SAb+ levels persisted in patients who did not achieve remission but significantly decreased in patients who achieved remission by the second biopsy. Patients who did not achieve remission also had a higher GAg+ rate on the first biopsy than patients who achieved remission (P<0.01). Sustained GAg+ deposits correlated with disease relapse. In conclusion, combining the measurements of SAb levels and detection of GAg deposition may provide additional information regarding diagnoses, treatment response, and disease relapse in patients with IMN.

Female Patient with Alport Syndrome and Concomitant Membranous Nephropathy: Susceptibility or Association of Two Diseases?

“…We then faced the question on whether the 2 lesion profiles were linked or not. Beck et al [12] as well as others [13] showed that ∼ 70% of patients with idiopathic MN have antibodies against PLA2R while secondary forms are predominantly serum negative, as verified in our patient. In this scenario, the likelihood is that the MN profile followed a secondary cause.…”

“…A patient presenting with sudden nephritic syndrome, history of unprotected sex habits, and very high levels of VDRL and FTAbS has been described [13] . In our patient, despite no other clinical signs of syphilis and very low serologic titles, one cannot fully exclude the Treponema antigen as the primary cause of this immuno-complex nephropathy.…”

Clinical Predictors of Response to Prednisone Plus Cyclophosphamide in Patients with Idiopathic Membranous Nephropathy

“…These findings suggest that the risk of relapse should be carefully monitored in the first year after attainment of a PR. Previous studies reported that patients with a sustained positive glomerular or serum PLA2R antibody deposition had a high risk of relapse [23,27] . According to Beck et al [28] , the high relapse risk for patients with only a PR may be due to a residual immunological disease in spite of the reduction of proteinuria.…”

Primary membranous nephropathy: comprehensive review and historical perspective

“…More importantly, PLA2R antibodies have also been reported to be of prognostic significance. Patients with positive PLA2R antibody titres at the time of biopsy have a lower rate of complete remission 14. Decreasing antibody titres suggest immunological remission which is generally followed by remission of proteinuria 15 16.…”