Etiology and Clinical Characteristics of Membranous Nephropathy in Chinese Patients

Zeng, Caihong; Chen, Hui-mei; Wang, Rui-Shi; Chen, Yan; Zhang, Suhua; Liu, Li; Leishi, LI; Liu, Zhihong

doi:10.1053/j.ajkd.2008.06.006

Cited by 56 publications

(43 citation statements)

References 33 publications

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“…Acute mercury poisoning mainly results in acute tubular necrosis, especially with involvement of the proximal tubules (10), whereas chronic mercury exposure mainly causes immune complex nephritis, especially MN (11). In this study, all patients showed membranous nephropathy in pathologic findings; most of the patients in this study were young and female, which is not consistent with the epidemiologic finding for idiopathic MN (2). It is thus hypothesized that they had secondary MN.…”

Section: Discussioncontrasting

confidence: 76%

“…The selected cases were required to meet the following criteria: (1) The histologic and immunopathologic changes of the patient were consistent with those of MN. (2) The patient had a clear history of contact with mercurycontaining preparations or staying in a mercury-containing environment. (3) The patient had no history of renal diseases or abnormal urinary tests before mercury exposure.…”

Section: Patient Selectionmentioning

confidence: 99%

“…MN may be classified as an idiopathic type and a secondary type associated with other clinical conditions or diseases, which include infections, autoimmune diseases, toxin or drugs, cancer, etc. (2).…”

mentioning

confidence: 99%

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Mercury-Induced Membranous Nephropathy

Zhang

Chen

et al. 2010

Clinical Journal of the American Society of Nephrology

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116

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Results: A total of 10 women and 1 man ages 15 to 45 years were enrolled in the present study. Mercury exposure was caused by mercury-containing pills (five patients), skin lightening cream (four patients), hair-dyeing agents (one patient), and mercury vapor (one patient). The duration of contact with mercury ranged from 2 to 60 months, and the urinary mercury concentrations were 1.5 to 50 times higher than reference values. All patients presented with proteinuria and normal renal function; three had nephrotic syndrome. Light microscopy revealed thickened glomerular basement membrane and mildly proliferative mesangial cells. Acute tubulointerstitial injury occurred in three patients. The immunofluorescence findings showed granular deposits of IgG and C3 along the glomerular capillary wall, mostly accompanied by deposits of C4 and C1q. IgG1 and IgG4 (predominantly IgG1) deposits were observed along the glomerular capillary loops. Nine patients reached complete remission in follow-up after withdrawal from mercury exposure.Conclusions: Deposits of IgG1 subclasses in renal tissues indicated that the pathogenesis of mercury-induced MN differs from that of idiopathic MN. It is important that clinicians are aware that mercury exposure should be considered a possible cause of membranous nephropathy.

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Section: Discussioncontrasting

confidence: 76%

Section: Patient Selectionmentioning

confidence: 99%

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Mercury-Induced Membranous Nephropathy

Zhang

Chen

et al. 2010

Clinical Journal of the American Society of Nephrology

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116

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“…It was reported that membranous nephropathy was much less common in the Chinese population than in the white population. [9][10][11][12][13][14] Although both HLA-DQA1 and PLA2R1 are associated with the development of membranous nephropathy in the Chinese population, PLA2R1 gene variance has shown a much stronger association with the development of IMN as well as the production of anti-PLA2R autoantibodies. In this study, we explored other SNPs in HLA-DOB and HLA-DQB2, which showed a relatively strong signal in European GWAS data; however, only HLA-DQA1 was identified as being associated with membranous nephropathy in the Chinese Han population.…”

Section: Discussionmentioning

confidence: 99%

“…[9][10][11][12][13][14] In this study, we aim to evaluate the association between these risk alleles and the development of IMN in a large Chinese cohort with .2000 participants and to further explore their roles in the generation of anti-PLA2R antibodies and expression of PLA2R in glomeruli.…”

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confidence: 99%

Interaction between PLA2R1 and HLA-DQA1 Variants Associates with Anti-PLA2R Antibodies and Membranous Nephropathy

Hou

Zhou

et al. 2013

Journal of the American Society of Nephrology

135

129

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Risk alleles at genome loci containing phospholipase A2 receptor 1 (PLA2R1) and HLA-DQA1 closely associate with idiopathic membranous nephropathy (IMN) in the European population, but it is unknown whether a similar association exists in the Chinese population and whether high-risk alleles promote the development of anti-PLA2R antibodies. Here, we genotyped 2132 Chinese individuals, including 1112 patients with IMN and 1020 healthy controls, for three single nucleotide polymorphisms (SNPs) within PLA2R1 and three SNPs within HLA genes. We also selected 71 patients, with varying genotypes, to assess for circulating anti-PLA2R antibody and for PLA2R expression in glomeruli. Three SNPs within PLA2R1 and one SNP within HLA-DQA1 strongly associated with IMN, and we noted gene-gene interactions involving these SNPs. Furthermore, these risk alleles strongly associated with the presence of anti-PLA2R antibodies and glomerular PLA2R expression. Among individuals who carried risk alleles for both genes, 73% had anti-PLA2R antibodies and 75% expressed PLA2R in glomeruli. In contrast, among individuals who carried protective genotypes of both genes, none had anti-PLA2R antibodies and glomerular expression of PLA2R was weak or absent. In conclusion, the interaction between PLA2R1 and HLA-DQA1 risk alleles associates with the development of IMN in the Chinese population. Individuals carrying risk alleles are predisposed to the generation of circulating anti-PLA2R autoantibodies, which may contribute to the development of IMN.

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