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Comparative analysis of membranous and other nephropathy subtypes and establishment of a diagnostic model

  • Hanyu Zhu
  • Bo Fu
  • Yong Wang
  • Jing Gao
  • Qiuxia Han
  • Wenjia Geng
  • Xiaoli Yang
  • Guangyan Cai
  • Xiangmei Chen
  • Dong Zhang
Research Article
  • 22 Downloads

Abstract

This study aimed to compare clinical features between membranous nephropathy (MN) and nonmembranous nephropathy (non-MN), to explore the clinically differential diagnosis of these two types, and to establish a diagnostic model of MN. After renal biopsy was obtained, 798 patients were divided into two groups based on their examination results: primary MN group (n = 248) and non-MN group (n = 550). Their data were statistically analyzed. Logistic regression analysis indicated that anti-PLA2R antibodies, IgG, and Cr were independently correlated with MN, and these three parameters were then used to establish the MN diagnostic model. A receiver operating characteristic (ROC) curve confirmed that our diagnostic model could distinguish between patients with and without MN, and their corresponding sensitivity, specificity, and AUC were 79.9%, 89.4%, and 0.917, respectively. The cutoff value for this combination in MN diagnosis was 0.34. The established diagnostic model that combined multiple factors shows a potential for broad clinical applications in differentiating primary MN from other kidney diseases and provides reliable evidence supporting the feasibility of noninvasive diagnosis of kidney diseases.

Keywords

multiparameter analysis diagnosis model membranous nephropathy 

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Notes

Acknowledgements

This study was supported by (1) National Key R&D Program of China (No. 2016YFC1305500), (2) the National Natural Science Foundation of China (Nos. 61471399 and 61671479), (3) Innovation Nursery Fund of PLA General Hospital (No. 15KMZ04), and (4) the National Natural Science Foundation of China (No. 81401719).

References

  1. 1.
    Ronco P, Debiec H. Pathophysiological advances in membranous nephropathy: time for a shift in patient’s care. Lancet 2015; 385 (9981): 1983–1992CrossRefPubMedGoogle Scholar
  2. 2.
    Beck LH Jr, Salant DJ. Membranous nephropathy: recent travels and new roads ahead. Kidney Int 2010; 77(9): 765–770CrossRefPubMedGoogle Scholar
  3. 3.
    Pan X, Xu J, Ren H, Zhang W, Xu Y, Shen P, Li X, Wang W, Chen X, Wu P, Feng X, Hao C, Chen N. Changing spectrum of biopsyproven primary glomerular diseases over the past 15 years: a singlecenter study in China. Contrib Nephrol 2013; 181(24): 22–30CrossRefPubMedGoogle Scholar
  4. 4.
    Xie J, Chen N. Primary glomerulonephritis in mainland China: an overview. Contrib Nephrol 2013; 181(43): 1–11PubMedGoogle Scholar
  5. 5.
    Ponticelli C. Membranous nephropathy. J Nephrol 2007; 20(3): 268–287PubMedGoogle Scholar
  6. 6.
    Ronco P, Debiec H. First identification of an antigen in autoimmune idiopathic membranous nephropathy: toward targeted therapy? Am J Kidney Dis 2010; 55(5): 820–823CrossRefPubMedGoogle Scholar
  7. 7.
    Bazzi C, Wight R. Urinary N-acetyl-β-glucosaminidase and e GFR may identify patients to be treated with immuno-suppression at diagnosis in idiopathic membranous nephropathy. Nephrology (Carlton) 2018; 23(2):175–182CrossRefGoogle Scholar
  8. 8.
    Wu X, Wen S, Zhu X, Yuan S, Xu X, Yang D, Sun L, Liu H, Liu F. Diagnostic value of renal phospholipase A2 receptor and serum antiphospholipase A2 receptor antibody in membranous nephropathy. Med J Cent South Univ (Zhong Nan Da Xue Xue Bao Yi Xue Ban) 2017; 42(4): 395–399 (in Chinese)Google Scholar
  9. 9.
    Beck LHJr, Bonegio RG, Lambeau G, Beck DM, Powell DW, Cummins TD, Klein JB, Salant DJ. M-type phospholipase A2 receptor as target antigen in idiopathic membranous nephropathy. N Engl J Med 2009; 361(1): 11–21CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Ortega LM, Schultz DR, Lenz O, Pardo V, Contreras GN. Lupus nephritis: pathologic features, epidemiology and a guide to therapeutic decisions. Lupus 2010; 19(5): 557–574CrossRefPubMedGoogle Scholar
  11. 11.
    Iwakura T, Fujigaki Y, Katahashi N, Sato T, Ishigaki S, Tsuji N, Naito Y, Isobe S, Ono M, Sakao Y, Tsuji T, Ohashi N, Kato A, Miyajima H, Yasuda H. Membranous nephropathy with an enhanced granular expression of thrombospondin type-1 domaincontaining 7A in a pregnant woman. Intern Med 2016; 55(18): 2663–2668CrossRefPubMedGoogle Scholar
  12. 12.
    Li Q, Lin X, Wu Z, He L, Wang W, Cao Q, Zhang J. Immunohistochemistry analysis of Helicobacter pylori antigen in renal biopsy specimens from patients with glomerulonephritis. Saudi J Kidney Dis Transpl 2013; 24(4): 751–758CrossRefPubMedGoogle Scholar
  13. 13.
    Li LS, Liu ZH. Epidemiologic data of renal diseases from a single unit in China: analysis based on 13, 519 renal biopsies. Kidney Int 2004; 66(3): 920–923CrossRefPubMedGoogle Scholar
  14. 14.
    Knehtl M, Debiec H, Kamgang P, Callard P, Cadranel J, Ronco P, Boffa JJ. A case of phospholipase A2 receptor-positive membranous nephropathy preceding sarcoid-associated granulomatous tubulointerstitial nephritis. Am J Kidney Dis 2011; 57(1): 140–143CrossRefPubMedGoogle Scholar
  15. 15.
    Ponticelli C, Passerini P. Can prognostic factors assist therapeutic decisions in idiopathic membranous nephropathy? J Nephrol 2010; 23(2): 156–163PubMedGoogle Scholar
  16. 16.
    Svobodova B, Honsova E, Ronco P, Tesar V, Debiec H. Kidney biopsy is a sensitive tool for retrospective diagnosis of PLA2Rrelated membranous nephropathy. Nephrol Dial Transplant 2013; 28 (7): 1839–1844CrossRefPubMedGoogle Scholar
  17. 17.
    Hofstra JM, Wetzels JF. Phospholipase A2 receptor antibodies in membranous nephropathy: unresolved issues. J Am Soc Nephrol 2014; 25(6): 1137–1139CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Dähnrich C, Komorowski L, Probst C, Seitz-Polski B, Esnault V, Wetzels JF, Hofstra JM, Hoxha E, Stahl RA, Lambeau G, Stöcker W, Schlumberger W. Development of a standardized ELISA for the determination of autoantibodies against human M-type phospholipase A2 receptor in primary membranous nephropathy. Clin Chim Acta 2013; 421(11): 213–218CrossRefPubMedGoogle Scholar
  19. 19.
    Quintana LF, Blasco M, Seras M, Pérez NS, López-Hoyos M, Villarroel P, Rodrigo E, Viñas O, Ercilla G, Diekmann F, Gómez-Roman JJ, Fernandez-Fresnedo G, Oppenheimer F, Arias M, Campistol JM. Antiphospholipase A2 receptor antibody levels predict the risk of posttransplantation recurrence of membranous nephropathy. Transplantation 2015; 99(8): 1709–1714CrossRefPubMedGoogle Scholar
  20. 20.
    Na W, Yi K, Song YS, Park MH. Dissecting the relationships of IgG subclasses and complements in membranous lupus nephritis and idiopathic membranous nephropathy. PLoS One 2017; 12(3): e0174501CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Li XL, Yan TK, Li HF, Xu PC, Jia JY, Wei L, Shang WY, Lin S. IgG4-related membranous nephropathy with high blood and low urine IgG4/IgG ratio: a case report and review of the literature. Clin Rheumatol 2014; 33(1): 145–148CrossRefPubMedGoogle Scholar
  22. 22.
    Branten AJ, du Buf-Vereijken PW, Klasen IS, Bosch FH, Feith GW, Hollander DA, Wetzels JF. Urinary excretion of β2-microglobulin and IgG predict prognosis in idiopathic membranous nephropathy: a validation study. J Am Soc Nephrol 2005; 16(1): 169–174CrossRefPubMedGoogle Scholar
  23. 23.
    Suzuki H, Moldoveanu Z, Hall S, Brown R, Julian BA, Wyatt RJ, Tomana M, Tomino Y, Novak J, Mestecky J. IgA nephropathy: characterization of IgG antibodies specific for galactose-deficient IgA1. Contrib Nephrol 2007; 157: 129–133PubMedGoogle Scholar
  24. 24.
    Gu QH, Cui Z, Huang J, Zhang YM, Qu Z, Wang F, Wang X, Wang SX, Liu G, Zhao MH. Patients with combined membranous nephropathy and focal segmental glomerulosclerosis have comparable clinical and autoantibody profiles with primary membranous nephropathy: a retrospective observational study. Medicine (Baltimore) 2016; 95(21): e3786CrossRefGoogle Scholar
  25. 25.
    Lemley KV, Bagnasco SM, Nast CC, Barisoni L, Conway CM, Hewitt SM, Song PX. Morphometry predicts early GFR change in primary proteinuric glomerulopathies: a longitudinal cohort study using generalized estimating equations. PLoS One 2016; 11(6): e0157148CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Wong E, Lasica M, He SZ, Bajel A, Roberts AW, Mason KD, Ritchie DS, Szer J. Nephrotic syndrome as a complication of chronic graft-versus-host disease after allogeneic haemopoietic stem cell transplantation. Intern Med J 2016; 46(6): 737–741CrossRefPubMedGoogle Scholar
  27. 27.
    Wang B, Yang H, Shen L, Wang J, Pu W, Chen Z, Shen X, Fu J, Zhuang Z. Rs56288038 (C/G) in 3'UTR of IRF-1 regulated by miR-502-5p promotes gastric cancer development. Cell Physiol Biochem 2016; 40(1-2): 391–399CrossRefPubMedGoogle Scholar
  28. 28.
    Togo K, Ueo T, Yonemasu H, Honda H, Ishida T, Tanabe H, Yao K, Iwashita A, Murakami K. Two cases of adenocarcinoma occurring in sporadic fundic gland polyps observed by magnifying endoscopy with narrow band imaging. World J Gastroenterol 2016; 22(40): 9028–9034CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Tabata N, Sueta D, Akasaka T, Arima Y, Sakamoto K, Yamamoto E, Izumiya Y, Yamamuro M, Tsujita K, Kojima S, Kaikita K, Morita K, Oniki K, Saruwatari J, Nakagawa K, Hokimoto S. Helicobacter pylori seropositivity in patients with interleukin-1 polymorphisms is significantly associated with ST-segment elevation myocardial infarction. PLoS One 2016; 11(11): e0166240CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Dong HR, Wang YY, Cheng XH, Wang GQ, Sun LJ, Cheng H, Chen YP. Retrospective study of phospholipase A2 receptor and IgG subclasses in glomerular deposits in Chinese patients with membranous nephropathy. PLoS One 2016; 11(5): e0156263CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Bastard JP, Fellahi S, Lescure FX, Capeau J, Ronco P, Plaisier E. Interest of the combined measurement of selected urinary proteins in the diagnosis approach in nephrology. Ann Biol Clin (Paris) 2017; 75(3): 327–333Google Scholar

Copyright information

© Higher Education Press and Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Hanyu Zhu
    • 1
  • Bo Fu
    • 1
  • Yong Wang
    • 1
  • Jing Gao
    • 2
  • Qiuxia Han
    • 3
  • Wenjia Geng
    • 1
  • Xiaoli Yang
    • 1
  • Guangyan Cai
    • 1
  • Xiangmei Chen
    • 1
  • Dong Zhang
    • 1
  1. 1.Department of NephrologyChinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing Key Laboratory of Kidney DiseaseBeijingChina
  2. 2.Department of Clinical BiochemistryChinese PLA General HospitalBeijingChina
  3. 3.Department of NephrologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina

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