Anti-phospholipase A2 Receptor Antibody Measurement in Patients with Idiopathic Membranous Nephropathy Diagnosed by Renal Biopsy

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membranous nephropathy, anti-PLA2R antibody, proteinuria, anti-phospholipase A2 receptor (anti-PLA2R) antibody, idiopathicmembranous nephropathy (IMN)


Objective: Our study is a cross-sectional study that aims to evaluate the presence and levels of anti-phospholipase A2 receptor (PLA2R) antibodies in healthy volunteers and idiopathic membranous nephropathy (IMN) patients and to assess the relationship between these levels and clinical parameters.

Methods: Serum anti-PLA2R antibody levels, complete blood count, urea, creatinine (Kre), total protein,albumin, low-density lipoprotein (LDL)-cholesterol, triglycerides (TG), high-density lipoprotein (HDL)-cholesterol, total cholesterol, C-reactive protein (crp), sedimentation, proteinuria were measured from 71 IMN patients and 48 healthy volunteers.

Results: Of the values compared between the two groups, the urea, creatinine, and modified diet renal disease (MDRD) were similar, total protein, albumin, LDL-cholesterol, TG, total cholesterol, HDL-cholesterol, and complete urinalysis protein values were statistically significantly high in the patient group, as expected in nephrotic syndrome (p<0.01). The anti-PLA2Rantibody levels measured using enzyme-linked immunosorbent assay (ELISA) in patient and control groups were found to be negative. The anti-PLA2R level was found to be 0.104 (0.093-0.129) ng/ml in the IMN group, while it was 0.141 (0.117-0.177) ng/ml in the control group (P=0,001). Although the P value was significant, the anti-PLA2R antibody level was found to be high in the control group and was outside the reference range of the kit.

Conclusion: There is a need to conduct more sensitive studies with a higher number of patients in order to distinguish between primary and secondary nature and to investigate the presence of anti-PLA2R in IMNpatients, which constitute the majority of nephrotic syndromes in adults. Antibody titer levels were observed to be low and it was revealed that the measurement range of the antibody kit used in the study should be more sensitive.


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Ponticelli, Claudio, and Richard J. Glassock. Glomerular diseases: membranous nephropathy—a modern view. Clin J Am Soc Nephrol.2014; 9(3): 609-616.

Beck L, Bomback AS, Choi MJ, Holzman LB, Langford C, Mariani LH, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for glomerulonephritis. Am. J. Kidney Dis.. 2013;62(3):403-41.

Heymann W, Hackel DB, Harwood S, Wilson SG, Hunter JL. Production of nephrotic syndrome in rats by Freund's adjuvants and rat kidney suspensions. Proc Soc Exp Biol Med. 1959; 100(4):660–664.

Debiec H, Guigonis V, Mougenot B, Decobert F, Haymann JP, Bensman A et al. Antenatal membranous glomerulonephritis due to anti–neutral endopeptidase antibodies. N Engl J Med. 2002; 346(26); 2053-2060.

Beck Jr, Laurence H, Bonegio RG, Lambeau G, Beck DM, Powell DW et al. M-type phospholipase A2 receptor as target antigen in idiopathic membranous nephropathy. N Engl J Med. 2009: 361(1); 11-21.

Glassock RJ. The pathogenesis of membranous nephropathy: evolution and revolution. Curr. Opin. Nephrol. Hypertens.2012: 21(3); 235-242.

Dai H, Zhang H, He Y. Diagnostic accuracy of PLA2R autoantibodies and glomerular staining for the differentiation of idiopathic and secondary membranous nephropathy: an updated meta-analysis. Sci Rep. 2015:5(1); 8803.

Svobodova B, Honsova E, Ronco P, Tesar V, Debiec H. Kidney biopsy is a sensitive tool for retrospective diagnosis of PLA2R-related membranous nephropathy. Nephrol. Dial. Transplant.. 2013: 28(7); 1839-1844.

Oh YJ, Yang SH, Kim DK, Kang SW, Kim YS. Autoantibodies against phospholipase A2 receptor in Korean patients with membranous nephropathy. PLoS One. 2013: 8(4); e62151.

Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D at al. (1999). A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Ann. Intern. Med. 1999: 130(6); 461-470.

Hoxha E, Thiele I, Zahner G, Panzer U, Harendza S, Stahl RA. Phospholipase A2 receptor autoantibodies and clinical outcome in patients with primary membranous nephropathy. J. Am. Soc. Nephrol. . 2014: 25(6); 1357-1366.

Dou Y, Zhang L, Liu D, Wang C, Quan S, Ma S et al. 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; 845-849.

Timmermans SA, Damoiseaux JG, Heerings-Rewinkel PT, Ayalon R, Beck Jr, Laurence H et al. Evaluation of anti-PLA2R1 as measured by a novel ELISA in patients with idiopathic membranous nephropathy: a cohort study. Am. J. Clin. Pathol. . 2014:142(1); 29-34.

Akiyama SI, Akiyama M, Imai E, Ozaki T, Matsuo S, Maruyama S. Prevalence of anti-phospholipase A2 receptor antibodies in Japanese patients with membranous nephropathy. Clin. Exp. Nephrol. 2015: 19; 653-660.

Hofstra JM, Debiec H, Short CD, Pellé T, Kleta R, Mathieson PW et al. Antiphospholipase A2 receptor antibody titer and subclass in idiopathic membranous nephropathy. J. Am. Soc. Nephrol. . 2012: 23(10); 1735-1743.

Qin W, Beck LH, Zeng C, Chen Z, Li S, Zuo K et al. Anti-phospholipase A2 receptor antibody in membranous nephropathy. J. Am. Soc. Nephrol. 2011: 22(6); 1137-1143.

Hoxha E, Harendza S, Pinnschmidt H, Panzer U, Stahl RA. PLA2R antibody levels and clinical outcome in patients with membranous nephropathy and non-nephrotic range proteinuria under treatment with inhibitors of the renin-angiotensin system. PLoS One. 2014: 9(10); e110681.

Ruggenent P, Debiec H, Ruggiero B, Chianca A, Pellé T, Gaspari F et al. Anti-phospholipase A2 receptor antibody titer predicts post-rituximab outcome of membranous nephropathy. J. Am. Soc. Nephrol . 2015: 26(10); 2545-255.

Van de Logt AE, Dahan K, Rousseau A, Van Der Molen R, Debiec H, Ronco P et al. Immunological remission in PLA2R-antibody–associated membranous nephropathy: cyclophosphamide versus rituximab. Kidney Int. 2018: 98(4); 1016-1017. doi:

Bobart SA, De Vriese AS, Pawar AS, Zand L, Sethi S, Giesen C et al. Noninvasive diagnosis of primary membranous nephropathy using phospholipase A2 receptor antibodies. . Kidney Int. 2019: 95(2); 429-438.

Chen P, Mao M, Wang C, Zhang X, Zhao X, Gao Y et al. Preliminary study on the efficacy of rituximab in the treatment of idiopathic membranous nephropathy: A single-centre experience. Front. Endocrinol. 2023: 14.

Van de Logt AE, Fresquet M, Wetzels JF and Brenchley P. The anti-PLA2R antibody in membranous nephropathy: what we know and what remains a decade after its discovery. Kidney Int. 2019: 96(6); 1292-1302.

Zhao Y, Cai M, Jiang Z, Dong B, Yan Y, Wang Y et al. Association of serum mannose-binding lectin, anti-phospholipase A2 receptor antibody and renal outcomes in idiopathic membranous nephropathy and atypical membranous nephropathy: a single center retrospective cohort study. Ren. Fail. 2022: 44(1); 428-433.

Li C, Li P, Guo W, Chen L, Li J, Wang R et al. (2022). The optimal anti-phospholipase A2 receptor cutoff for the diagnosis of idiopathic membranous nephropathy: a single-center retrospective study. Korean J Intern Med. 2022: 37(1); 154.



How to Cite

Öztürk, S.; Usalan, O.; Usalan, C.; Ozdemir, O. Anti-Phospholipase A2 Receptor Antibody Measurement in Patients With Idiopathic Membranous Nephropathy Diagnosed by Renal Biopsy. Eur J Ther 2023.



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