Journal
CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY
Volume 16, Issue 12, Pages 1833-1839Publisher
AMER SOC NEPHROLOGY
DOI: 10.2215/CJN.05480421
Keywords
membranous nephropathy; kidney biopsy; receptors; phospholipase A2; glomerulonephritis; membranous
Categories
Funding
- National Institutes of Health [2P30DK063608-16, R01DK126959, UM1DK100876]
- National Institute of Diabetes and Digestive and Kidney Diseases
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The study aimed to investigate whether a positive anti-phospholipase A2 receptor antibody test through immunological testing can confirm the diagnosis of membranous nephropathy without the need for kidney biopsy. The results showed that in certain specific conditions, a positive antibody test can effectively diagnose membranous nephropathy.
Background and objectives Kidney biopsy is the current gold standard to diagnose membranous nephropathy. Approximately 70%-80% of patients with primary membranous nephropathy have circulating anti-phospholipaseA2 receptor antibodies. We previously demonstrated that in proteinuric patients with preserved eGFR and absence of associated conditions (e.g.,autoimmunity, malignancy, infection, drugs, and paraproteinemia), a positive anti-phospholipase A2 receptor antibody test by ELISA and immunofluorescence assay confirms the diagnosis of membranous nephropathy noninvasively. These data have not been externally validated. Design, setting, participants, & measurements The clinical and pathologic characteristics of patients with a positive anti-phospholipase A2 receptor antibody test at the Mayo Clinic, the University Hospital Vall DHebron(Barcelona), and the Columbia University Medical Center (New York) were retrospectively reviewed. Biopsy findings and presence or absence of a potential associated condition were assessed. Results From a total of 276 patients with positive anti-phospholipase A2 receptor serology, previously reported patients (n533), kidney transplant recipients (n59), pediatric patients (n52), and patients without kidney biopsy(n569) were excluded. Among the 163 remaining patients, associated conditions were identified in 47 patients, and 15 patients had diabetes mellitus. All 101 patients of the final cohort had a primary diagnosis of membranous nephropathy on kidney biopsy. In the 79 patients with eGFR$60 ml/min per 1.73 m2, none of the biopsy finding saltered diagnosis or management. Among the 22 patients with decreased eGFR, additional findings included super imposed acute interstitial nephritis (n51).Conclusions In patients with preserved eGFR and absence of associated conditions or diabetes, a positive anti-phospholipase A2 receptor test by either ELISA.20 RU/ml or a positive immunofluorescence assay confirms the diagnosis of membranous nephropathy, precluding the requirement for a kidney biopsy.
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