Primary Membranous Glomerulonephritis: The Role of Serum and Urine Biomarkers in Patient Management.

Maifata Maifata,Hod Hod,Abd Ghani Abd Ghani,Zakaria Zakaria

doi:10.3390/biomedicines7040086

Maifata Maifata, Hod Hod + Show 2 more

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https://doi.org/10.3390/biomedicines7040086

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Journal: Biomedicines	Publication Date: Nov 1, 2019
Citations: 10	License type: CC BY 4.0

Affiliation: Federal University Lafia, Universiti Putra Malaysia

Abstract

The detection of phospholipase A2 receptor (PLA2R) and thrombospondin domain containing 7A THSD7A among primary membranous glomerulonephritis (MGN) patients transformed the diagnosis, treatment monitoring, and prognosis. Anti-PLA2R can be detected in 70–90% of primary MGN patients while anti-THSD7A in 2–3% of anti-PLA2R negative primary MGN patients depending on the technique used. Serum and urine samples are less invasive and non-invasive, respectively, and thus can detect the presence of anti-PLA2R and anti-THSD7A with higher sensitivity and specificity, which is significant in patient monitoring and prognosis. It is better than exposing patients to a frequent biopsy, which is an invasive procedure. Different techniques of detection of PLA2R and THSD7A in patients’ urine and sera were reviewed to provide newer and alternative techniques. We proposed the use of biomarkers (PLA2R and THSD7A) in the diagnosis, treatment decision, and follow-up of patients with primary MGN. In addition, other prognostic renal biomarkers like retinol binding protein (RBP) and beta-2 microglobulin were reviewed to detect the progression of renal damage for early intervention.

Highlights

Membranous glomerulonephritis (MGN) is characterized by the deposit of the immune complex at the subepithelial region of the glomerular membrane and the formation of perpendicular projection similar to the glomerular basement membrane (GBM) found between podocyte cytoplasm and GBM [1].The histological characteristics of membranous glomerulonephritis (MGN) include GBM thickening, staining of the C3 complement along the periphery of glomerular capillaries, granular staining for immunoglobulin G subtype, and deposition of the immune complex at the subepithelium found exclusively in primary MGN [2].Studies have shown that MGN is the most common cause of nephrotic syndrome among adults, consisting of up to 20% of cases among Hispanic and African Americans
We proposed the use of biomarkers (PLA2 R and thrombospondin domain containing 7A (THSD7A)) in the diagnosis, treatment decision, and follow-up of patients with primary MGN
Other prognostic renal biomarkers like retinol binding protein (RBP) and beta-2 microglobulin were reviewed to detect the progression of renal damage for early intervention

Summary

Introduction

Membranous glomerulonephritis (MGN) is characterized by the deposit of the immune complex at the subepithelial region of the glomerular membrane and the formation of perpendicular projection similar to the glomerular basement membrane (GBM) found between podocyte cytoplasm and GBM [1].The histological characteristics of MGN include GBM thickening, staining of the C3 complement along the periphery of glomerular capillaries, granular staining for immunoglobulin G subtype, and deposition of the immune complex at the subepithelium found exclusively in primary MGN [2].Studies have shown that MGN is the most common cause of nephrotic syndrome among adults, consisting of up to 20% of cases among Hispanic and African Americans. Membranous glomerulonephritis (MGN) is characterized by the deposit of the immune complex at the subepithelial region of the glomerular membrane and the formation of perpendicular projection similar to the glomerular basement membrane (GBM) found between podocyte cytoplasm and GBM [1]. The histological characteristics of MGN include GBM thickening, staining of the C3 complement along the periphery of glomerular capillaries, granular staining for immunoglobulin G subtype, and deposition of the immune complex at the subepithelium found exclusively in primary MGN [2]. Studies have shown that MGN is the most common cause of nephrotic syndrome among adults, consisting of up to 20% of cases among Hispanic and African Americans. Whites are the most affected, followed by Asians, Africans, and Hispanics [3,4]. The disease is predominantly seen among adults aged 40–50 years, with a male to female ratio of (2:1)–(3:1) [5]

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