Abstract
Background
Recently, great progress has been made in understanding the pathogenesis of membranous nephropathy (MN) with the discovery of autoantibodies (Abs) to M-type phospholipase A2 receptor (PLA2R) in serum and in immunocomplexes deposited in glomerulus in most adult patients with primary MN.
Objective
To evaluate the diagnostic performance of anti-PLA2R in Brazilian patients with MN, as well as to verify the possible association of anti-PLA2R serum levels with disease activity.
Methods
117 patients with glomerular diseases confirmed by renal biopsy underwent routinely clinical and laboratory evaluation (serum creatinine and albumin, 24-h proteinuria, urinalysis, tests for etiological investigation) and determination of serum anti-PLA2R by ELISA.
Results
67.5% of the patients had MN, 9.4% focal segmental glomerulosclerosis, 7.7% lupus nephritis class V and 15.4%, other proteinuric glomerular diseases. The mean level of glomerular filtration rate (estimated by the CKD-EPI formula) was 79.43 mL/min (12.00–151.20 mL/min), 24 h proteinuria of 2.89 g (0–14.90 g), serum albumin of 3.79 g/dL (1.20–4.80 g/dL). Anti-PLA2R was detected in 27 patients, all with active MN, being 26 primary and 1 secondary MN. Sensitivity and specificity rates for the test were 60.5–94.7%, and positive (PPV) and negative (NPV) predictive values were 92.9 and 67.9%, respectively.
Conclusions
Anti-PLA2R showed high specificity and PPV for the diagnosis of primary MN in Brazilian patients. There was a strong correlation between disease activity and positive anti-PLA2R. This biomarker represents an important diagnostic tool for primary MN and may contribute to the monitoring of disease activity in such patients.
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Funded by Conselho Nacional de Desenvolvimento Científico e Tecnológico (BR), Grant no. 001.
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Santos Neto, C.O., Passos, M.T., Fernandes, D.E. et al. Autoantibodies against phospholipase A2 receptor in Brazilian patients with glomerular diseases. Int Urol Nephrol 53, 733–738 (2021). https://doi.org/10.1007/s11255-020-02682-w
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DOI: https://doi.org/10.1007/s11255-020-02682-w