Autoantibodies against phospholipase A2 receptor in Brazilian patients with glomerular diseases

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. Ob...

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Published in:International urology and nephrology 2021-04, Vol.53 (4), p.733-738
Main Authors: Santos Neto, Cícero de Oliveira, Passos, Michelle T., Fernandes, Danilo E., Nishida, Sonia K., Andrade, Luís Eduardo Coelho, Mastroianni Kirsztajn, Gianna
Format: Article
Language:English
Subjects:
Albumin
Autoantibodies
Biopsy
Creatinine
Disease
Enzyme-linked immunosorbent assay
Glomerular filtration rate
Glomerulus
Lupus nephritis
Medicine
Medicine & Public Health
Membranous nephropathy
Nephritis
Nephrology
Nephrology - Original Paper
Nephropathy
Phospholipase A2
Proteinuria
Serum levels
Urinalysis
Urology
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Summary: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.
ISSN:0301-1623
1573-2584
DOI:10.1007/s11255-020-02682-w