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Kidney biopsy is a sensitive tool for retrospective diagnosis of PLA2R-related membranous nephropathy

Barbora Svobodova1, Eva Honsova, Pierre Ronco

  • 1Department of Nephrology, First Faculty of Medicine and General University Hospital, Prague, Czech Republic.

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
|December 11, 2012
PubMed
Abstract

Insights

Detecting phospholipase A2 receptor (PLA2R) antigen in kidney biopsies is more sensitive than serological tests for diagnosing PLA2R-related membranous nephropathy, especially with delayed serum samples.

Area of Science:

  • Nephrology
  • Immunology
  • Pathology

Background:

  • Antibodies against M-type phospholipase A2 receptor (PLA2R) are key serological markers for idiopathic membranous nephropathy (iMN) disease activity.
  • Diagnosis of PLA2R-related membranous nephropathy (MN) relies on identifying these antibodies or the antigen.

Purpose of the Study:

  • To determine the most sensitive diagnostic test for PLA2R-related MN, irrespective of sample timing.
  • To compare the sensitivity of detecting circulating anti-PLA2R antibodies versus PLA2R antigen in kidney biopsies.

Main Methods:

  • Retrospective analysis of 84 Czech patients with biopsy-proven MN (idiopathic, lupus, secondary).
  • Tested archival kidney biopsies for glomerular PLA2R immune deposits.
  • Measured circulating anti-PLA2R antibodies using indirect immunofluorescence.

Main Results:

  • PLA2R antigen detected in 69% of iMN kidney biopsies.
  • Circulating anti-PLA2R antibodies found in 65% of active disease sera, but 6 patients were negative despite biopsy positivity.
  • PLA2R antigen was detected in biopsies more frequently (59%) than antibodies (22%) in remission sera.

Conclusions:

  • In cases of delayed serum sampling, PLA2R antigen assessment in kidney biopsies is more sensitive for diagnosing PLA2R-related MN.
  • Kidney biopsy analysis allows for retrospective diagnosis of PLA2R-related MN when serological tests are negative.
Keywords:
PLA2Rhepatitis Bkidney biopsylupusmembranous nephropathysarcoidosis

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