Abstract
BackgroundTo discuss the clinicopathological features and prognosis of patients with idiopathic membranous nephropathy (IMN) who are serum-negative for the anti-PLA2R antibody.MethodOverall, 229 IMN patients were retrospectively collected in this study and classified into anti-PLA2R antibody-negative (PLA2R−, 59 cases) and antibody-positive (PLA2R+, 170 cases) groups. The clinical and pathological features of the PLA2R− group were analyzed; 162 patients in both groups were followed up, and the PLA2R antigen was detected in renal biopsies from the PLA2R− group. Kaplan-Meier and survival analyses were used to compare differences in prognosis.ResultsSerum albumin levels were higher and 24-hour urine protein, creatinine, and beta 2-microglobulin (BMG) levels were lower in the PLA2R− group than in the PLA2R+ group; the proportion of acute and chronic tubular lesions was also significantly lower in the PLA2R− group than in in the PLA2R+ group. After treatment, the remission rate was significantly higher in the negative group than in the positive group (93.02% vs 74.78%,), especially the rate of complete remission (51.16% vs 23.47%). Furthermore, the PLA2R antigen-positive staining rate of 43 patients in the PLA2R− group was 62.79%. Although not significant, the survival rate was higher in the PLA2R− group than in the PLA2R+ group. BMG, 24-hour urine protein and acute and chronic tubular lesions were risk factors for kidney death, and 24-hour urine protein was an independent risk factor for kidney death.ConclusionsCompared with the PLA2R+ group, the PLA2R− group had mild clinical manifestations and pathological damage and a higher clinical treatment remission rate. Renal tissue PLA2R antigen testing can be considered for patients with seronegative IMN to increase the diagnostic rate.
Highlights
Membranous nephropathy with unclear etiology is called idiopathic membranous nephropathy (IMN) and accounts for 30∼40% of all cases of primary nephrotic syndrome (Braden et al, 2000; Couser, 2017)
Renal tissue PLA2R antigen testing can be considered for patients with seronegative IMN to increase the diagnostic rate
The expression of PLA2R antigen in renal tissue was significantly enhanced in IMN patients, and low or no expression was observed in patients with secondary membranous nephropathy (SMN) and other nonmembranous glomerular diseases, indicating that the PLA2R antigen in renal tissue has high specificity in the diagnosis of IMN
Summary
Membranous nephropathy with unclear etiology is called idiopathic membranous nephropathy (IMN) and accounts for 30∼40% of all cases of primary nephrotic syndrome (Braden et al, 2000; Couser, 2017). Beck et al found that serum antiPLA2R antibodies were detectable in 70% of patients with IMN and detected at a low rate in people without kidney disease and other kidney patients (Hofstra & Wetzels, 2014). In addition to serum PLA2R antibodies, a number of clinical studies (Beck et al, 2009; Dai, Zhang & He, 2015; Svobodova et al, 2013) have found that the detection of PLA2R antigen in renal tissue plays an important role in the clinical diagnosis, guiding treatment and judgment of disease activity of IMN. To discuss the clinicopathological features and prognosis of patients with idiopathic membranous nephropathy (IMN) who are serum-negative for the antiPLA2R antibody. Compared with the PLA2R+ group, the PLA2R− group had mild clinical manifestations and pathological damage and a higher clinical treatment remission rate
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