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Clinical and Experimental Nephrology

, Volume 19, Issue 5, pp 797–803 | Cite as

Clinicopathological characteristics of M-type phospholipase A2 receptor (PLA2R)-related membranous nephropathy in Japanese

  • Norifumi Hayashi
  • Shin’ichi Akiyama
  • Hiroshi Okuyama
  • Yuki Matsui
  • Hiroki Adachi
  • Hideki Yamaya
  • Shoichi Maruyama
  • Enyu Imai
  • Seiichi Matsuo
  • Hitoshi YokoyamaEmail author
Original Article

Abstract

Background

Recent studies have suggested that assessments of serum antibodies against M-type phospholipase A2 receptor (PLA2R) and the glomerular expression of PLA2R antigen in biopsy specimens are useful for the diagnosis of primary membranous nephropathy (MN). In this study, we assessed both of them and investigated the clinicopathological characteristics of PLA2R-related Japanese MN.

Methods

We retrospectively enrolled 22 primary and 3 secondary Japanese patients whose serum samples and renal specimens were collected before treatment. According to the findings of serum antibodies and antigen in glomeruli, the primary MN patients were classified into PLA2R-related or -unrelated MN. We compared their clinicopathological findings, including IgG subclass staining, and electron microscopic findings, and evaluated the predictors of proteinuria remission.

Results

In primary MN, 16 patients (73 %) were classified into the PLA2R-related group, and 6 patients into the PLA2R-unrelated group. There was no significant difference in baseline laboratory data and electron microscopic findings, except for eGFR and serum IgG levels. IgG4-dominant deposition was more common in the related group (63 vs. 0 %). The 10 PLA2R-related patients with dominant IgG4 deposition had a lower rate and prolonged time in remission compared with the 6 PLA2R-related patients with non-dominant IgG4 (log-rank, p = 0.032). Furthermore, dominant IgG4 deposition was an unfavorable predictor of remission by multivariable Cox proportional hazard analysis.

Conclusions

Assessments of both serum PLA2R antibodies and PLA2R antigen in glomeruli were more sensitive for the diagnosis of PLA2R-related MN, and among affected Japanese patients, those with dominant IgG4 deposition had worse clinical outcomes.

Keywords

Electron microscopic findings IgG subclass staining Membranous nephropathy Phospholipase A2 receptor Western blotting 

Notes

Acknowledgments

We are grateful to the staff members of the Division of Nephrology for their cooperation and support. This study was supported in part by Grants-in-Aid for Scientific Research from the Japan Society for the Promotion of Science; (C) No.25461237 (HY), (B) No.24406029 (HY), and (B) No.2530502 (HY, SM), and a Grant-in-Aid for Progressive Renal Disease Research and Intractable Renal Disease Research, Research on Rare and Intractable Diseases, and Health and Labour Sciences Research Grants from the Ministry of Health, Labour, and Welfare of Japan.

Conflict of interest

None of the authors has any competing interests.

Supplementary material

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Supplementary material 1 (DOCX 13 kb)
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Supplementary material 5 (PDF 65 kb)

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Copyright information

© Japanese Society of Nephrology 2014

Authors and Affiliations

  • Norifumi Hayashi
    • 1
  • Shin’ichi Akiyama
    • 2
  • Hiroshi Okuyama
    • 1
  • Yuki Matsui
    • 1
  • Hiroki Adachi
    • 1
  • Hideki Yamaya
    • 1
  • Shoichi Maruyama
    • 2
  • Enyu Imai
    • 2
  • Seiichi Matsuo
    • 2
  • Hitoshi Yokoyama
    • 1
    Email author
  1. 1.Division of NephrologyKanazawa Medical UniversityUchinadaJapan
  2. 2.Division of Nephrology, Department of Internal MedicineNagoya University Graduate School of MedicineNagoyaJapan

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