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The association of serum anti-PLA2R antibody and glomerular PLA2R antigen staining with clinical manifestations and outcomes in membranous nephropathy

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Abstract

Background

Phospholipase A2 receptor (PLA2R)-associated membranous nephropathy (MN) was manifested as seropositive for PLA2R antibodies (SAb) and/or glomerular PLA2R antigens’ (GAg) deposits. According to the test of SAb and GAg, PLA2R-associated MN can be divided into SAb + /GAg−, SAb−/GAg + , and SAb + /GAg + groups. The clinical characteristics and outcomes of the three groups need to be further evaluated.

Methods

184 PLA2R-associated MN patients were enrolled. SAb was measured by enzyme-linked immunosorbent assay with a cut-off value of 14 RU/mL. GAg was detected by immunofluorescence using a paraffin section of renal biopsy samples. Clinical characteristics and the decline of eGFR were compared among the 3 groups.

Results

There were 33 SAb + /GAg−, 46 SAb−/GAg +, and 105 SAb + /GAg + PLA2R-associated MN patients reviewed. Clinical characteristics, such as the level of proteinuria, serum albumin, as well as eGFR, were comparable between the SAb + /GAg− and SAb + /GAg + patients. While SAb−/GAg + patients exhibited mild clinical manifestations as evidenced by higher serum albumin (P < 0.001) and lower proteinuria (p = 0.049) compared with SAb + /GAg + patients. After 21.96 ± 7.39 month follow-up, the eGFR decrease was no difference between the SAb + /GAg− and SAb + /GAg + patients. SAb−/GAg + patients had a lower rate of the > 20% eGFR decline as well as a 50% eGFR decline compared with the SAb + /GAg + patients (10.87% vs 30.48%, p = 0.013; 0.00% vs 4.76%, p = 0.324).

Conclusions

Our study showed that the clinical manifestations of SAb + /Gag− patients were the same as those of double-positive patients, while SAb−/GAg + patients exhibited mild clinical manifestations and slower eGFR decline compared to the double-positive patients.

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Data availability

The datasets compiled in the current study are available from the corresponding author upon reasonable request.

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Funding

This study was supported by Shaanxi Provincial Natural Science Foundation (2020JQ-500).

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Authors and Affiliations

  1. Department of Nephrology, Kidney Hospital, The First Affiliated Hospital, School of Medicine, Xi’an Jiaotong University, Xi’an City, 710061, Shaanxi Province, China

    Shi-Feng Yang, Xin-Fang Xie, Wan-Hong Lu, Ping Lan & Li Jin

  2. Biobank, The First Affiliated Hospital, School of Medicine, Xi’an Jiaotong University, Xi’an, 710061, Shaanxi, China

    Hui Liu

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  1. Shi-Feng Yang
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Contributions

All authors participated in the design, analysis, and interpretation of the data as well as in the review of the manuscript. SFY, PL, HL, and LJ conducted data collection; SFY, XFX, WHL, and LJ provided conceptualization; SFY, WHL, and LJ wrote the manuscript.

Corresponding author

Correspondence to Li Jin.

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The authors declare that there are no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were following the ethical standards of the institutional research committee at which the studies were conducted and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Because of the retrospective nature of the study, patient consent for inclusion was waived.

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Yang, SF., Xie, XF., Lu, WH. et al. The association of serum anti-PLA2R antibody and glomerular PLA2R antigen staining with clinical manifestations and outcomes in membranous nephropathy. Clin Exp Nephrol 27, 1060–1066 (2023). https://doi.org/10.1007/s10157-023-02399-x

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  • DOI: https://doi.org/10.1007/s10157-023-02399-x

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