Primary membranous nephropathy in adolescence: A prospective study.

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.