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Primary membranous nephropathy in adolescence: A prospective study

Vinod Kumar1, Ashwani Kumar Varma1, Ritambhra Nada2

  • 1Department of Nephrology, Histopathology and Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Nephrology (Carlton, Vic.)
|June 24, 2016
PubMed
Abstract

Insights

Primary membranous nephropathy (PMN) in adolescents is often linked to antibodies against the phospholipase A2 receptor (aPLA2R). While many cases show aPLA2R involvement, only about half achieve clinical remission, highlighting the need for targeted monitoring.

Area of Science:

  • Nephrology
  • Immunology
  • Pediatric Nephrology

Background:

  • Primary membranous nephropathy (PMN) is rare in children, accounting for 1-2% of nephrotic syndrome cases.
  • Antibodies to the phospholipase A2 receptor (aPLA2R) are implicated in a majority of adult PMN cases.
  • The role of aPLA2R in adolescent PMN requires further investigation.

Purpose of the Study:

  • To investigate the prevalence of aPLA2R in adolescent-onset PMN.
  • To analyze the clinical presentation and behavior of PMN in adolescents.
  • To assess the correlation between aPLA2R status and treatment response in this age group.

Main Methods:

  • Prospective observational study of 18 adolescent patients (10-19 years) with biopsy-proven PMN.
  • Monthly monitoring of proteinuria, serum albumin, and creatinine.
  • Serum aPLA2R testing at baseline, 6, and 12 months; glomerular aPLA2R staining performed.

Main Results:

  • PMN was aPLA2R-related in 83% of adolescent cases.
  • aPLA2R antibodies and enhanced glomerular staining were present in 77.78% and 72.22% of patients, respectively.
  • Clinical remission was achieved in 61.11% at 6 months and 50% at 12 months, with a significant association between aPLA2R and remission/resistance.

Conclusions:

  • Over three-quarters of adolescent PMN cases are associated with aPLA2R.
  • Therapeutic response in adolescent PMN is observed in approximately half of the patients.
  • aPLA2R monitoring is clinically significant and recommended for managing adolescent-onset PMN.
Keywords:
PLA2Radolescentchildhoodmembranous nephropathypediatrictacrolimus

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