Anti-phospholipase A2 receptor antibody screening in nephrotic syndrome may identify a distinct subset of patients with primary membranous nephropathy

Author(s):  
Roxana Jurubiță ◽  
Bogdan Obrișcă ◽  
Camelia Achim ◽  
Georgia Micu ◽  
Bogdan Sorohan ◽  
...  
2020 ◽  
Author(s):  
Lili Liu ◽  
Haitao Wang ◽  
Ban Zhao ◽  
Xin Liu ◽  
Ying Sun ◽  
...  

Abstract BackgroundThe biomarkers predicting long-term outcome of idiopathic membranous nephropathy (IMN) with nephrotic syndrome (NS) remains indeterminacy. We conducted this study to evaluate the different features between phospholipase A2 receptor (PLA2R)-associated and non-PLA2R-associated IMN, and to explore the association between serum PLA2R antibody (PLA2R-Ab), urinary immunoglobulin G (UIgG), urinary α1-macroglobulin (Uα1m) and renal outcomes in patients with idiopathic membranous nephropathy (IMN) and nephrotic syndrome (NS). MethodsIMN patients who were biopsy-proven and presenting NS were retrospectively recruited for the present study. Serum PLA2R-Ab levels were detected by enzyme-linked immunosorbent assay (ELISA) kits, and values over 20 RU/mL was considered positive. UIgG) and Uα1m were measured by immunonephelometry and corrected by urinary creatinine. The clinicopathologic features, remission and renal outcome were compared between the PLA2R-associated and non-PLA2R-associated IMN patients. Furthermore, the predictive values of biomarkers (PLA2R-Ab, UIgG/Cr and Uα1m/Cr) for remission and renal outcome were assessed by multivariate regression. The renal endpoint was defined as progression to end stage kidney disease (ESRD) or estimated glomerular filtration rate (eGFR) decline ≥50% of baseline. ResultsA total of 111 IMN patients were enrolled this study, and 81 (73.0%) of them were PLA2R-associated. The mean age, 24-hour proteinuria and eGFR showed no difference between PLA2R-associated and non-PLA2R-associated groups (p>0.05). However, PLA2R-associated IMN patients had significantly higher UIgG/Cr (17.78 vs. 9.82 mg/g; median, p=0.001) and Uα1m (0.339 vs 0.202 mg/g; median, p<0.001) when compared to non-PLA2R-associated patients. Histologically, the PLA2R-associated group represented more proportion of patients with acute tubular necrosis (ATN) (27.16% vs. 3.33%, P=0.006) and glomerular C3 deposits (88.89% vs. 70.00%, P=0.016) than the non-PLA2R-associated group. During a median follow-up of 40 months (range 9 to 92), non-PLA2R-associated patients had significantly higher remission rate at the 6th and 12th month and end of follow-up, even after adjusting for the use of immunosuppressor. Furthermore, 11 (13.6%) patients reaching renal endpoint were all PLA2R-associated IMN. Multivariate regression analysis represented that baseline serum PLA2R-Ab titer was an independent predictor of remission (OR, 1.002; 95% confidence interval [CI] 1.001 to 1.004; p=0.002) and renal outcome (HR, 1.002; 95% CI 1.001-1.003, p= 0.004). Receiver operating characteristic (ROC) showed that serum PLA2R-Ab titer >216.93 RU/ml (AUC=0.778, p=0.003), UIgG/Cr >15.76mg/g (AUC=0.758, p=0.005) and Uα1m/Cr >0.3042mg/g (AUC=0.738, p=0.010) predicted renal failure in patients with IMN and NS. Kaplan-Meier curves indicated that subjects with combination of all three high biomarkers had significantly shorter renal survival (log rank p=0.007) than subjects with ≤2 high biomarkers. ConclusionHigh PLA2R-Ab levels is poor prognosis predictor of IMN in addition to proteinuria. In addition, combination of multiple factors (PLA2R-Ab, UIgG and Uα1m) represents a stronger predictive power. These findings suggested the potential different pathogenesis and progression in IMN with NS. Keywords: idiopathic membranous nephropathy, phospholipase A2 receptor antibody, urinary IgG, urinary α1- macroglobulin, nephrotic syndrome.


2018 ◽  
Vol 37 (3) ◽  
pp. 248-256 ◽  
Author(s):  
Eun Joo Song ◽  
Kye Hwa Jeong ◽  
Young Ae Yang ◽  
Jeong-Hoon Lim ◽  
Hee-Yeon Jung ◽  
...  

2012 ◽  
Vol 5 (2) ◽  
pp. 162-165 ◽  
Author(s):  
S. Surindran ◽  
R. Ayalon ◽  
N. Hasan ◽  
L. H. Beck ◽  
D. J. Salant ◽  
...  

2017 ◽  
Vol 7 (1) ◽  
pp. 16-21 ◽  
Author(s):  
Monika Yachha ◽  
Raj Kumar Sharma ◽  
Sonia Mehrotra ◽  
Narayan Prasad ◽  
Amit Gupta ◽  
...  

2018 ◽  

There is little information about pregnancy outcomes in patients with active membranous nephropathy (MN), especially those with circulating autoantibodies to M-type phospholipase A2 receptor (PLA2R), the major autoantigen in primary MN. Membranous glomerulonephritis (MGN) represents an immunologically mediated disease characterized by deposition of immune complexes in the glomerular subepithelial space, frequently associated with circulating M-type phospholipase A2 receptor. Nephrotic syndrome (massive proteinuria and hypoalbuminemia) at diagnosis predicts poor prognosis. Pregnancy with active MGN is high risk for foetal loss, intrauterine growth restriction, and pre-eclampsia, and may worsen maternal renal function, especially with the presence of antiphospholipid antibody syndrome (APLA). We report a 23-year-old gravida in her first pregnancy, suffering from MGN and severe nephrotic syndrome, complicated by APLA syndrome. The patient was treated with enoxaparin, aspirin azathioprine, and Prednisone for a short time, in addition to furosemide and albumin intravenously. She was delivered at 30 weeks due to deteriorating maternal and foetal conditions. A successful neonatal and maternal outcome was achieved in this case. The patient's history revealed thrombocytopenia and APLA syndrome and continues to be treated chronically with enoxaparin. Kidney biopsy performed after delivery showed membranous MGN stage II-III. Herein, we present a case of successful pregnancy and foetal outcome in a young woman with APLA syndrome and MN. Keywords: Membranous GN, Nephrotic Syndrome, Anti-Phospholipid Antibodies.


2021 ◽  
Vol 5 (2.1) ◽  
pp. 8
Author(s):  
Qipeng Huang ◽  
Gaosi Xu ◽  
Fang Wang ◽  
Fang Zeng ◽  
Weidong Fang

Objective: To assess the correlation between Serum phospholipase A2 receptor antibody and clinicopathological features in patients with membranous nephropathy. Method: The patients being hospitalized for renal biopsy were selected in this study from January 2016 to January 2018. And normal controls were randomly selected; all the patients were divided into idiopathic membranous nephropathy and non-idiopathic membranous nephropathy groups; patients with idiopathic membranous nephropathy were divided into three groups, namely stage I, stage II and stage III; using software for statistical analysis. Results: A total of 357 patients were enrolled, including 155 patients with idiopathic membranous nephropathy, 183 patients with non-idiopathic membranous nephropathy, and 19 cases for normal controls. The average age of the idiopathic membranous nephropathy (IMN) group is higher than that of the membranous nephropathy group (P = 0.01). Different pathological stages of idiopathic membranous nephropathy general clinical characteristics analysis results showed that the age, cys c, serum creatinine (Scr) in stage III membranous nephropathy group were higher than those of the stage I and II membranous nephropathy (P values were 0.003, 0.000 and 0.000 respectively); titers of serum phospholipase A2 receptors antibody with stage II and III membranous nephropathy higher than the stage I membranous nephropathy group (P = 0.006); serum albumin (Alb) levels correlated inversely with serum anti-PLA2R antibody titers (rs = –0.234, P = 0.003), serum antiphospholipase A2 receptor (PLA2R) antibody titer level in patients with idiopathic membranous nephropathy was significantly higher than that in patients with non-membranous nephropathy (P < 0.001). Conclusion: Baseline titer of serum anti-PLA2R antibody is negatively correlated with Alb in the IMN patients,and serum anti-PLA2R antibody level in patients with stage I IMN was significantly lower than stage II and III IMN patients.


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