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Profile of Indian Patients With Membranous Nephropathy

Priyadarsani Subramanian1, Hemanth Kumar1, Bipin Tiwari1

  • 1Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.

Kidney International Reports
|September 21, 2020
PubMed
Abstract

Insights

This study found phospholipase A2 receptor (PLA2R)-related membranous nephropathy (MN) in 72.8% of Indian adults and 44% of pediatric patients. Thrombospondin type 1 domain-containing 7A (THSD7A)-related MN was found in 3.4% of adults, showing similar prevalence to global data.

Area of Science:

  • Nephrology
  • Immunology
  • Pathology

Background:

  • Primary membranous nephropathy (MN) is increasingly linked to autoantibodies against podocyte antigens, notably phospholipase A2 receptor (PLA2R) and thrombospondin type 1 domain-containing 7A (THSD7A).
  • Limited data exists on PLA2R-related MN in Indian populations, and THSD7A-related MN is undocumented in this demographic.
  • Understanding these antigen profiles is crucial for accurate diagnosis and management of MN.

Purpose of the Study:

  • To determine the prevalence of PLA2R and THSD7A in a large cohort of Indian adult and pediatric patients with membranous nephropathy.
  • To characterize the baseline immunological profile of MN in the Indian population.
  • To compare findings with international literature.

Main Methods:

  • Retrospective analysis of MN cases (primary and secondary) between 2014 and 2017.
  • PLA2R direct immunofluorescence on kidney biopsies and anti-PLA2R enzyme-linked immunosorbent assay (ELISA) on baseline sera.
  • THSD7A immunohistochemistry on kidney biopsies.

Main Results:

  • Membranous nephropathy (MN) accounted for 10% of kidney biopsies. PLA2R-related primary MN prevalence was 72.8% (combining tissue and serum tests) with moderate concordance (kappa=0.61).
  • PLA2R was found in 16.7% of secondary MN cases, predominantly lupus MN. THSD7A prevalence in primary MN was 3.4%.
  • Dual PLA2R and THSD7A positivity occurred in 2 cases. In pediatric MN, PLA2R prevalence was 44% (tissue testing), with one THSD7A-positive case.

Conclusions:

  • Prevalence rates of PLA2R- and THSD7A-related MN in this large Indian cohort align with global findings, including in pediatric cases.
  • The study highlights variations in MN, such as discordant PLA2R testing results, dual antigen positivity, and secondary MN with PLA2R/THSD7A positivity.
  • Findings underscore the importance of antigen profiling in diverse populations for understanding and managing membranous nephropathy.
Keywords:
ELISAPLA2RTHSD7Amembranous nephropathythrombospondin

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