Diagnostic Value of Renal Biopsy in Anti-phospholipase A2 Receptor Antibody-positive Patients with Proteinuria in China

Overview

Journal Sci Rep

Specialty Science

Date 2024 Feb 5

PMID 38316889

Authors

Shan Lu

Jing Xiao

Dong Liu

Yan Zhang

Yijun Dong

Zhanzheng Zhao

Affiliations

Soon will be listed here.

Abstract

Renal biopsy remains the gold standard for diagnosing membranous nephropathy (MN). Recent studies have suggested that renal biopsy can be replaced with the serum phospholipase A2 receptor (PLA2R) antibody test for MN diagnosis in patients with nephrotic syndrome. However, this test has not been validated in the Chinese population. In this study, we investigated whether renal biopsy provides additional diagnostic information on patients with proteinuria who are seropositive for PLA2R antibodies (SAb +). We retrospectively reviewed the clinicopathological characteristics of SAb + adult patients (aged ≥ 18 years) with proteinuria (≥ 0.5 g/24 h) assessed at the Department of Nephrology, the First Affiliated Hospital of Zhengzhou University, from June 2021 to March 2022. Among a total of 801 SAb + patients who received renal biopsy, those with incomplete pathological data, diabetes or any potential cause of secondary MN were excluded. Among the 491 remaining patients, 474 had primary MN (PMN), 16 had atypical MN (AMN, 9 patients with "full house" and 2 patients with HBsAg + /HBcAg + immunofluorescence results), and 1 had focal segmental glomerulosclerosis. In patients with an eGFR of ≥ 60 mL/min/1.73 m (n = 451), 436 had PMN, and 71 (16.3%) exhibited additional biopsy findings, with obesity-related glomerulopathy being the most common. In patients with an impaired eGFR (n = 40), 38 had PMN, and 31 (81.6%) showed additional findings, with acute tubular injury being the most common. In conclusion, anti-PLA2R antibody positivity is highly predictive of PMN in Chinese adults but often coexists with other pathological diagnoses. The advantages of renal biopsy for detecting other pathologies should be weighed against the potential risks of the biopsy procedure.

References

McGrogan A, Franssen C, de Vries C . The incidence of primary glomerulonephritis worldwide: a systematic review of the literature. Nephrol Dial Transplant. 2010; 26(2):414-30. DOI: 10.1093/ndt/gfq665. View

Bobart S, Han H, Tehranian S, De Vriese A, Leon Roman J, Sethi S . Noninvasive Diagnosis of PLA2R-Associated Membranous Nephropathy: A Validation Study. Clin J Am Soc Nephrol. 2021; 16(12):1833-1839. PMC: 8729491. DOI: 10.2215/CJN.05480421. View

Li Y, Yu X, Zhang W, Lv J, Lan P, Wang Z . Epidemiological characteristics and pathological changes of primary glomerular diseases. PLoS One. 2022; 17(8):e0272237. PMC: 9387823. DOI: 10.1371/journal.pone.0272237. View

Pakfetrat M, Malekmakan L, Torabinezhad S, Yousefi O, Naddaffard D . Review of Renal Biopsies, A Single Center Experience. Iran J Kidney Dis. 2020; 14(1):12-19. View

Hu R, Quan S, Wang Y, Zhou Y, Zhang Y, Liu L . Spectrum of biopsy proven renal diseases in Central China: a 10-year retrospective study based on 34,630 cases. Sci Rep. 2020; 10(1):10994. PMC: 7335090. DOI: 10.1038/s41598-020-67910-w. View

Couser W . Primary Membranous Nephropathy. Clin J Am Soc Nephrol. 2017; 12(6):983-997. PMC: 5460716. DOI: 10.2215/CJN.11761116. View

Wu X, Liu L, Guo Y, Yang L . Clinical value of a serum anti-PLA2R antibody in the diagnosis and monitoring of primary membranous nephropathy in adults. Int J Nephrol Renovasc Dis. 2018; 11:241-247. PMC: 6159797. DOI: 10.2147/IJNRD.S176665. View

Ragy O, Rautemaa V, Smith A, Brenchley P, Kanigicherla D, Hamilton P . Can use of the serum anti-PLA2R antibody negate the need for a renal biopsy in primary membranous nephropathy?. PLoS One. 2023; 18(2):e0281726. PMC: 9955960. DOI: 10.1371/journal.pone.0281726. View

Dou Y, Zhang L, Liu D, Wang C, Quan S, Ma S . The accuracy of the anti-phospholipase A2 receptor antibody in the diagnosis of idiopathic membranous nephropathy: a comparison of different cutoff values as measured by the ELISA method. Int Urol Nephrol. 2016; 48(6):845-9. DOI: 10.1007/s11255-016-1263-6. View

10.

Bobart S, De Vriese A, Pawar A, Zand L, Sethi S, Giesen C . Noninvasive diagnosis of primary membranous nephropathy using phospholipase A2 receptor antibodies. Kidney Int. 2019; 95(2):429-438. DOI: 10.1016/j.kint.2018.10.021. View

11.

Wiech T, Stahl R, Hoxha E . Diagnostic role of renal biopsy in PLAR1-antibody-positive patients with nephrotic syndrome. Mod Pathol. 2019; 32(9):1320-1328. DOI: 10.1038/s41379-019-0267-z. View

12.

Taguchi T, Oyamada M, Harada T . [Pathology of membranous nephropathy]. Nihon Jinzo Gakkai Shi. 2011; 53(5):684-91. View

13.

Luo J, Zhang W, Su C, Zhou Z, Wang G . Seropositive PLA2R-associated membranous nephropathy but biopsy-negative PLA2R staining. Nephrol Dial Transplant. 2020; 36(12):2216-2223. DOI: 10.1093/ndt/gfaa239. View

14.

Luo J, Yuan Y, Tian J, Zhou Z, Su C, Yang F . Clinicopathological Characteristics and Outcomes of PLAR-Associated Membranous Nephropathy in Seropositive Patients Without PLAR Staining on Kidney Biopsy. Am J Kidney Dis. 2022; 80(3):364-372. DOI: 10.1053/j.ajkd.2022.01.426. View

15.

Jiang Z, Cai M, Dong B, Yan Y, Wang Y, Li X . Renal outcomes of idiopathic and atypical membranous nephropathy in adult Chinese patients: a single center retrospective cohort study. BMC Nephrol. 2021; 22(1):148. PMC: 8063350. DOI: 10.1186/s12882-021-02348-4. View

16.

SIMENHOFF M, MERRILL J . THE SPECTRUM OF LUPUS NEPHRITIS. Nephron. 1964; 1:348-75. DOI: 10.1159/000179349. View

17.

Jiang Z, Cai M, Dong B, Yan Y, Yang B, Wang M . Clinicopathological features of atypical membranous nephropathy with unknown etiology in adult Chinese patients. Medicine (Baltimore). 2018; 97(32):e11608. PMC: 6133607. DOI: 10.1097/MD.0000000000011608. View

18.

Rijnink E, Teng Y, Kraaij T, Wolterbeek R, Bruijn J, Bajema I . Idiopathic non-lupus full-house nephropathy is associated with poor renal outcome. Nephrol Dial Transplant. 2017; 32(4):654-662. DOI: 10.1093/ndt/gfx020. View

19.

Sam R, Joshi A, James S, Jen K, Amani F, Hart P . Lupus-like membranous nephropathy: Is it lupus or not?. Clin Exp Nephrol. 2014; 19(3):395-402. DOI: 10.1007/s10157-014-1002-1. View

20.

Liu J, Liang W, Jing W, Liu M . Countdown to 2030: eliminating hepatitis B disease, China. Bull World Health Organ. 2019; 97(3):230-238. PMC: 6453311. DOI: 10.2471/BLT.18.219469. View