The Diagnosis Accuracy of PLA2R-AB in the Diagnosis of Idiopathic Membranous Nephropathy: A Meta-Analysis

Abstract

BackgroundThe presence of antibodies against the M-type phospholipase A2 receptor (PLA2R-AB) is considered to be a promising serological diagnostic biomarker of idiopathic membranous nephropathy (iMN). However, controversy remains about the diagnostic accuracy of serum PLA2R-AB testing. Here, we performed a comprehensive meta-analysis to assess the overall diagnostic value of serum PLA2R-AB testing in iMN detection.MethodsPubMed, Embase, and CNKI (Chinese National Knowledge Infrastructure) were searched for relevant original articles through January 31, 2014. The summary sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio (DOR) were estimated using the bivariate model. The heterogeneity among studies was explored by subgroup and meta-regression analysis.Results9 articles, including 15 studies, were eventually identified with a total of 2212 patients. The summary sensitivity of all studies is 78% (95% CI: 66% to 87%) and the specificity is 99% (95% CI: 96% to 100%). The summary positive and negative likelihood ratios are 96.1 (95% CI, 19.5 to 472.1) and 0.22 (95% CI: 0.14 to 0.35), respectively. The DOR is 437 (95%CI, 74 to 2592). The subgroup analysis and meta-regression suggest the test interval is the main source of heterogeneity.ConclusionsSerum PLA2R-AB testing is a useful tool to detect iMN. In addition, considering the high heterogeneity and potential publication bias, further high quality studies are needed in the future.

Pharmacological treatment of primary membranous nephropathy in 2016

“…Because of the high specificity of aPLA2R for the diagnosis of MN [87], it is likely that in five years a kidney biopsy will no longer be required to diagnose MN in patients with detectable anti-PLA2R antibodies.…”

Anti-Phospholipase A2 Receptor Antibodies as Diagnostic Modality in Primary Idiopathic Membranous Nephropathy

“…[20] Another similar study for PLA2R displayed 99% specificity and 78% sensitivity for the diagnosis of primary MN with tissue staining and serology distinguishing most cases of primary MN from secondary . [21] Larsen et al in his series of 85 primary MN and 80 secondary MN found sensitivity of 75% (95% CI: 65−84%) and specificity of 83% (95% CI: 72−90%). [14] Hence absence of circulating anti-PLA2R autoantibody at the time of kidney biopsy does not rule out a diagnosis of PLA2R-related MN.…”

Membranous nephropathy: A fairy tale for immunopathologists, nephrologists and patients

“…In a recent meta-analysis including 2212 patients, specificity was 99% (95% CI: 96% to 100%) and sensitivity was 78% (95% CI: 66% to 87%) (48). Anti-PLA2R antibodies are neither found in other nephropathies and auto-immune diseases nor detected in healthy individuals.…”