Diagnostic value of phospholipase A2 receptor in idiopathic membranous nephropathy: a systematic review and
Shou-Liang Hu1, Dan Wang, Wen-Jun Gou
1Division of Nephrology, The First Hospital of JingZhou, Yangtze University, Hangkongstreet 8, Jingzhou, 434000, Hubei, China.
Background:
Detection of M-type phospholipase A2 receptor (PLA2R) can be used in serologic diagnosis of idiopathic membranous nephropathy (IMN), but there are limited data about the sensitivity and specificity of its diagnostic values.
Methods And Results:
Meta-analysis of diagnostic test studies assessing the values of PLA2R in diagnosis of IMN. MEDLINE, EMBASE, and CENTRAL databases and congress abstracts were searched for studies reporting the value of PLA2R to predict IMN. The quality of the studies was evaluated using the guidelines of the updated Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. The results are summarized as sensitivity, specificity, and diagnostic odds ratio (OR). Data from 10 studies involving 1,550 participants were analyzed. Across all settings, the diagnostic OR for serum anti-PLA2R level to predict IMN at different stages was 247.41, with sensitivity of 0.69 and specificity of 0.99. The estimated sensitivity and specificity of serum anti-PLA2R level for diagnosis of IMN in the active stage were 74.0 and 95.0%, respectively, with diagnostic OR of 54.22. The estimated sensitivity and specificity of biopsy anti-PLA2R for diagnosis of IMN at different stages was 73.0 and 83.0%, respectively, with diagnostic OR of 13.75.
Conclusions:
This meta-analysis shows that serum anti-PLA2R level is of diagnostic value for IMN in the active stage. Future large-cohort prospective studies are required to reveal the diagnostic value of circulating anti-PLA2R antibodies versus PLA2R antigens in kidney biopsy for IMN at different stages.
Insights
Serum anti-M-type phospholipase A2 receptor (PLA2R) levels are valuable for diagnosing active idiopathic membranous nephropathy (IMN). This meta-analysis confirms its diagnostic utility, though further research is needed for different stages.
Area of Science:
- Nephrology
- Immunology
- Diagnostic Accuracy
Background:
- Idiopathic membranous nephropathy (IMN) diagnosis can utilize M-type phospholipase A2 receptor (PLA2R) detection.
- Limited data exist on the diagnostic sensitivity and specificity of PLA2R testing for IMN.
Purpose of the Study:
- To conduct a meta-analysis assessing the diagnostic accuracy of PLA2R detection for IMN.
- To evaluate the sensitivity, specificity, and diagnostic odds ratio of PLA2R in IMN diagnosis.
Main Methods:
- Meta-analysis of diagnostic test studies identified through comprehensive database searches (MEDLINE, EMBASE, CENTRAL) and congress abstracts.
- Quality assessment of included studies using the QUADAS-2 tool.
- Analysis of data from 10 studies with 1,550 participants.
Main Results:
- Serum anti-PLA2R levels demonstrated a high diagnostic odds ratio (247.41) for IMN across all stages (sensitivity 0.69, specificity 0.99).
- In the active stage, serum anti-PLA2R testing showed 74.0% sensitivity and 95.0% specificity (diagnostic OR 54.22).
- Biopsy anti-PLA2R detection had 73.0% sensitivity and 83.0% specificity (diagnostic OR 13.75) for IMN at different stages.
Conclusions:
- Serum anti-PLA2R antibody levels are diagnostically valuable for IMN, particularly in the active stage.
- Further prospective studies are needed to compare circulating antibodies versus kidney biopsy PLA2R antigens for IMN diagnosis across various stages.
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