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The investigative burden of membranous nephropathy in the UK
Patrick Hamilton1,2, Fiona Wilson1, Rajkumar Chinnadurai2,3
1Manchester Institute of Nephrology and Transplantation, Manchester Royal Infirmary, Manchester, UK.
Background:
Membranous nephropathy (MN) represents two distinct disease entities. Primary MN is now recognized as an autoimmune condition associated with the anti-PLA2R antibody and secondary MN occurs in tandem with malignancy, infection, drug therapy and other autoimmune conditions. Prior to the development of accessible enzyme-linked immunosorbent assays, the diagnosis of MN was one of exclusion. We studied whether the introduction of serum anti-PLA2R antibody testing leads to a reduction in the frequency of investigations in MN patients.
Methods:
Patients from three UK centres with a diagnosis of MN between 2009 and 2014 were identified. We compared patients who had a positive anti-PLA2R test within 6 months of biopsy with those who had no test or a negative test. Records were reviewed for investigations that took place 6 months prior to and 6 months following the biopsy date to see if these were normal or identified a secondary cause of MN.
Results:
In total, 184 patients were included: 80 had no test, 66 had a negative anti-PLA2R test and 38 had a positive test within 6 months of diagnosis. In 2012, 46.5% of patients had an anti-PLA2R test, increasing to 93.3% in 2014. From 2012 to 2014 the number of screening tests dropped from 10.03 to 4.29 and the costs from £497.92 to £132.94.
Conclusions:
Since its introduction, a progressively higher proportion of patients diagnosed with MN had an anti-PLA2R test. This has led to a reduction in the number of screening tests and in the cost of investigations carried out. The anti-PLA2R test has the potential to reduce this burden as its use becomes more widespread.
Insights
The introduction of anti-phospholipase A2 receptor (anti-PLA2R) antibody testing in membranous nephropathy (MN) diagnosis significantly reduced the number and cost of investigations. This diagnostic advancement streamlines patient workups and lowers healthcare expenses.
Area of Science:
- Nephrology
- Immunology
- Diagnostic Medicine
Background:
- Membranous nephropathy (MN) comprises primary autoimmune MN linked to anti-PLA2R antibodies and secondary MN associated with other conditions.
- Historically, MN diagnosis relied on exclusion, necessitating extensive investigations.
- The advent of anti-PLA2R antibody testing offers a more targeted diagnostic approach.
Purpose of the Study:
- To evaluate the impact of introducing serum anti-PLA2R antibody testing on the frequency and cost of investigations in MN patients.
- To assess the diagnostic yield of anti-PLA2R testing in differentiating primary MN from secondary causes.
Main Methods:
- Retrospective analysis of 184 MN patients from three UK centers (2009-2014).
- Comparison of patients with positive anti-PLA2R tests versus those with negative or no tests.
- Review of investigations conducted 6 months before and after biopsy to identify secondary causes.
Main Results:
- Anti-PLA2R testing increased from 46.5% in 2012 to 93.3% in 2014.
- The number of screening tests per patient decreased from 10.03 to 4.29.
- Associated investigation costs dropped from £497.92 to £132.94 per patient.
Conclusions:
- Widespread adoption of anti-PLA2R testing in MN diagnosis has led to a significant reduction in unnecessary investigations.
- This diagnostic shift streamlines patient management and decreases healthcare costs.
- Further integration of anti-PLA2R testing holds potential to alleviate the diagnostic burden in MN.
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