Abstract
BackgroundThe association between psoriasis and membranous nephropathy (MN) remains largely unclear. We examined the prevalence of serum PLA2R antibody and characterized the expression of PLA2R and THSD7A in glomeruli in patients with MN and psoriasis.MethodsA total of 24 patients with MN without evidence of a secondary cause except psoriasis were enrolled. The clinical and pathological features were retrospectively analyzed. Serum anti-PLA2R antibody was measured using IFA Mosaic. Renal tissue samples stored in the laboratory bio-bank were used for PLA2R staining under immunofluorescence microscopy and THSD7A immunohistochemical analysis.ResultsTwenty-four patients (21 male and 3 female) with a mean age of 43.6 ± 15.7 years old were enrolled. Serum anti-PLA2R antibody was positive in 7 patients, which was significantly lower than the positivity observed in idiopathic MN (29.2% vs. 81.7%, P < 0.001). Glomerular PLA2R staining was positive in 7 patients with positive serum anti-PLA2R antibody. THSD7A staining was negative in all 24 patients. During the follow-up visits, 13 patients with negative serum PLA2R antibody achieved CR. In contrast, CR was only achieved in 1 patient with positive serum PLA2R antibody, PR was achieved in 2 patients.ConclusionsThe prevalence of serum anti-PLA2R antibody and glomerular expression of PLA2R was significantly lower in patients with psoriasis and MN than in those with idiopathic MN, and THSD7A staining was negative, suggesting that MN is associated with psoriasis in the majority of patients. However, idiopathic MN might also accompany psoriasis in a minority of psoriatic patients with positive serum anti-PLA2R antibody.
Highlights
The association between psoriasis and membranous nephropathy (MN) remains largely unclear
MN associated with psoriasis has been documented in case reports, describing improvements in both MN and skin lesions in psoriatic patients and the complete remission of proteinuria and skin symptoms after the successful treatment of psoriasis, there have been no studies concerning the glomerular expression of phospholipase A2 receptor (PLA2R) and THSD7A in patients with psoriasis and MN
The distribution of glomerular IgG subclasses further indicated that MN was secondary in cases of psoriasis with negative serum PLA2R antibody, and idiopathic MN might be coincident with the occurrence of psoriasis in patients with positive serum PLA2R antibody
Summary
The association between psoriasis and membranous nephropathy (MN) remains largely unclear. We examined the prevalence of serum PLA2R antibody and characterized the expression of PLA2R and THSD7A in glomeruli in patients with MN and psoriasis. Membranous nephropathy (MN) is a renal disease characterized by subepithelial immune deposits in the glomerulus and is the common cause of nephrotic syndrome in adults. In 2009, M-type phospholipase A2 receptor (PLA2R) was first reported as a major target antigen for idiopathic MN, and serum autoantibodies to PLA2R can be detected in 70% of patients with idiopathic MN [2]. Psoriasis is typically limited to the skin; increasing evidence suggests that this condition is associated with systemic disorders, including arthritis, cardiovascular disease, metabolic syndrome, cancer, Crohn’s disease, and diabetes mellitus [7, 8].
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