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Analyses of Proteinuria, Renal Infiltration of Leukocytes, and Renal Deposition of Proteins in Lupus-prone MRL/lpr Mice
Published on: June 8, 2022
Serum anti-PLA2R negativity does not exclude glomerular PLA2R expression in primary membranous nephropathy
Şenay Yıldırım1, Ayça İnci2, Ayşe Karaduru Avcı3
1Department of Pathology, Antalya Training and Research Hospital, Antalya, Türkiye.
Biomolecules & Biomedicine
|June 10, 2026
Summary
In primary membranous nephropathy, serum anti-PLA2R antibody tests can be negative even when tissue tests show PLA2R positivity. Renal biopsy with immunohistochemistry remains vital for diagnosing seronegative cases.
Area of Science:
- Nephrology
- Immunology
- Pathology
Background:
- Primary membranous nephropathy (pMN) is a leading cause of nephrotic syndrome in adults.
- The M-type phospholipase A2 receptor (PLA2R) is a key antigen in pMN, and serum antibody levels aid diagnosis.
- The relationship between serum antibody titers and kidney tissue antigen deposition needs further clarification.
Purpose of the Study:
- To analyze the correlation between clinicopathological parameters, serum anti-PLA2R antibody levels, and glomerular PLA2R tissue expression in pMN.
- To evaluate the diagnostic utility of tissue staining, especially in seronegative patients.
Main Methods:
- Retrospective analysis of 49 adult pMN patients diagnosed via renal biopsy.
- Quantification of serum anti-PLA2R antibodies using ELISA.
- Assessment of glomerular PLA2R expression and staining intensity via immunohistochemistry (IHC) on kidney tissue.
Main Results:
- Serum anti-PLA2R antibody positivity was observed in 49.0% of patients.
- Tissue PLA2R expression was detected in 100% of cases, including all seronegative patients.
- Significant difference in tissue PLA2R staining intensity based on serum status (p=0.002); no correlation between titers and renal function/proteinuria.
Conclusions:
- Negative serum anti-PLA2R serology does not rule out tissue PLA2R positivity, possibly due to the 'kidney-as-a-sink' phenomenon.
- Serum and tissue PLA2R markers are complementary.
- Renal biopsy with IHC remains essential for diagnosing pMN, particularly in seronegative individuals.
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