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PLA2R antibodies and PLA2R glomerular deposits in psoriasis patients with membranous nephropathy
Yong-Chun Ge1, Bo Jin2, Cai-Hong Zeng2
1National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu, 210016, People's Republic of China. gyc_626828@126.com.
Background:
The association between psoriasis and membranous nephropathy (MN) remains largely unclear. We examined the prevalence of serum PLA2R antibody and characterized the expression of PLA2R and THSD7A in glomeruli in patients with MN and psoriasis.
Methods:
A total of 24 patients with MN without evidence of a secondary cause except psoriasis were enrolled. The clinical and pathological features were retrospectively analyzed. Serum anti-PLA2R antibody was measured using IFA Mosaic. Renal tissue samples stored in the laboratory bio-bank were used for PLA2R staining under immunofluorescence microscopy and THSD7A immunohistochemical analysis.
Results:
Twenty-four patients (21 male and 3 female) with a mean age of 43.6 ± 15.7 years old were enrolled. Serum anti-PLA2R antibody was positive in 7 patients, which was significantly lower than the positivity observed in idiopathic MN (29.2% vs. 81.7%, P < 0.001). Glomerular PLA2R staining was positive in 7 patients with positive serum anti-PLA2R antibody. THSD7A staining was negative in all 24 patients. During the follow-up visits, 13 patients with negative serum PLA2R antibody achieved CR. In contrast, CR was only achieved in 1 patient with positive serum PLA2R antibody, PR was achieved in 2 patients.
Conclusions:
The prevalence of serum anti-PLA2R antibody and glomerular expression of PLA2R was significantly lower in patients with psoriasis and MN than in those with idiopathic MN, and THSD7A staining was negative, suggesting that MN is associated with psoriasis in the majority of patients. However, idiopathic MN might also accompany psoriasis in a minority of psoriatic patients with positive serum anti-PLA2R antibody.
Insights
Psoriasis is rarely associated with the common cause of membranous nephropathy (MN), anti-PLA2R antibody. Most MN cases in psoriasis patients are not linked to PLA2R or THSD7A, suggesting a distinct pathway.
Area of Science:
- Nephrology
- Immunology
- Dermatology
Background:
- The link between psoriasis and membranous nephropathy (MN) is not well understood.
- This study investigates the prevalence of serum PLA2R antibody and glomerular expression of PLA2R and THSD7A in MN patients with psoriasis.
Purpose of the Study:
- To determine the prevalence of anti-PLA2R antibodies in patients with psoriasis and MN.
- To characterize PLA2R and THSD7A expression in kidney glomeruli of these patients.
- To differentiate MN associated with psoriasis from idiopathic MN.
Main Methods:
- Retrospective analysis of 24 MN patients with psoriasis.
- Measurement of serum anti-PLA2R antibody using IFA Mosaic.
- Immunofluorescence and immunohistochemical analysis of renal tissue for PLA2R and THSD7A expression.
Main Results:
- Serum anti-PLA2R antibody positivity was significantly lower (7/24, 29.2%) in psoriasis patients with MN compared to idiopathic MN (81.7%).
- Glomerular PLA2R staining was positive in 7 patients with positive serum antibodies; THSD7A staining was negative in all cases.
- Patients negative for anti-PLA2R antibodies showed higher rates of complete remission (CR).
Conclusions:
- The majority of MN cases in psoriasis patients are not associated with anti-PLA2R or THSD7A.
- This suggests a distinct pathogenesis for MN in this cohort, differing from idiopathic MN.
- A minority of psoriasis patients may have co-existing idiopathic MN with positive anti-PLA2R antibodies.
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