Norifumi Hayashi1, Shin'ichi Akiyama2, Hiroshi Okuyama1, Yuki Matsui1, Hiroki Adachi1, Hideki Yamaya1, Shoichi Maruyama2, Enyu Imai2, Seiichi Matsuo2, Hitoshi Yokoyama3. 1. Division of Nephrology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan. 2. Division of Nephrology, Department of Internal Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan. 3. Division of Nephrology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan. h-yoko@kanazawa-med.ac.jp.
Abstract
BACKGROUND: Recent studies have suggested that assessments of serum antibodies against M-type phospholipase A2 receptor (PLA2R) and the glomerular expression of PLA2R antigen in biopsy specimens are useful for the diagnosis of primary membranous nephropathy (MN). In this study, we assessed both of them and investigated the clinicopathological characteristics of PLA2R-related Japanese MN. METHODS: We retrospectively enrolled 22 primary and 3 secondary Japanese patients whose serum samples and renal specimens were collected before treatment. According to the findings of serum antibodies and antigen in glomeruli, the primary MN patients were classified into PLA2R-related or -unrelated MN. We compared their clinicopathological findings, including IgG subclass staining, and electron microscopic findings, and evaluated the predictors of proteinuria remission. RESULTS: In primary MN, 16 patients (73 %) were classified into the PLA2R-related group, and 6 patients into the PLA2R-unrelated group. There was no significant difference in baseline laboratory data and electron microscopic findings, except for eGFR and serum IgG levels. IgG4-dominant deposition was more common in the related group (63 vs. 0 %). The 10 PLA2R-related patients with dominant IgG4 deposition had a lower rate and prolonged time in remission compared with the 6 PLA2R-related patients with non-dominant IgG4 (log-rank, p = 0.032). Furthermore, dominant IgG4 deposition was an unfavorable predictor of remission by multivariable Cox proportional hazard analysis. CONCLUSIONS: Assessments of both serum PLA2R antibodies and PLA2R antigen in glomeruli were more sensitive for the diagnosis of PLA2R-related MN, and among affected Japanese patients, those with dominant IgG4 deposition had worse clinical outcomes.
BACKGROUND: Recent studies have suggested that assessments of serum antibodies against M-type phospholipase A2 receptor (PLA2R) and the glomerular expression of PLA2R antigen in biopsy specimens are useful for the diagnosis of primary membranous nephropathy (MN). In this study, we assessed both of them and investigated the clinicopathological characteristics of PLA2R-related Japanese MN. METHODS: We retrospectively enrolled 22 primary and 3 secondary Japanese patients whose serum samples and renal specimens were collected before treatment. According to the findings of serum antibodies and antigen in glomeruli, the primary MN patients were classified into PLA2R-related or -unrelated MN. We compared their clinicopathological findings, including IgG subclass staining, and electron microscopic findings, and evaluated the predictors of proteinuria remission. RESULTS: In primary MN, 16 patients (73 %) were classified into the PLA2R-related group, and 6 patients into the PLA2R-unrelated group. There was no significant difference in baseline laboratory data and electron microscopic findings, except for eGFR and serum IgG levels. IgG4-dominant deposition was more common in the related group (63 vs. 0 %). The 10 PLA2R-related patients with dominant IgG4 deposition had a lower rate and prolonged time in remission compared with the 6 PLA2R-related patients with non-dominant IgG4 (log-rank, p = 0.032). Furthermore, dominant IgG4 deposition was an unfavorable predictor of remission by multivariable Cox proportional hazard analysis. CONCLUSIONS: Assessments of both serum PLA2R antibodies and PLA2R antigen in glomeruli were more sensitive for the diagnosis of PLA2R-related MN, and among affected Japanese patients, those with dominant IgG4 deposition had worse clinical outcomes.
Entities:
Keywords:
Electron microscopic findings; IgG subclass staining; Membranous nephropathy; Phospholipase A2 receptor; Western blotting
Authors: Marco Prunotto; Maria Luisa Carnevali; Giovanni Candiano; Corrado Murtas; Maurizio Bruschi; Emilia Corradini; Antonella Trivelli; Alberto Magnasco; Andrea Petretto; Laura Santucci; Silvia Mattei; Rita Gatti; Francesco Scolari; Peter Kador; Landino Allegri; Gian Marco Ghiggeri Journal: J Am Soc Nephrol Date: 2010-02-11 Impact factor: 10.121
Authors: T Ehrenreich; J G Porush; J Churg; L Garfinkel; S Glabman; M H Goldstein; E Grishman; S L Yunis Journal: N Engl J Med Date: 1976-09-30 Impact factor: 91.245
Authors: Barbora Svobodova; Eva Honsova; Pierre Ronco; Vladimir Tesar; Hanna Debiec Journal: Nephrol Dial Transplant Date: 2012-12-06 Impact factor: 5.992
Authors: Hanna Debiec; Melanie Hanoy; Arnaud Francois; Dominique Guerrot; Sophie Ferlicot; Catherine Johanet; Pierre Aucouturier; Michel Godin; Pierre Ronco Journal: J Am Soc Nephrol Date: 2012-11-02 Impact factor: 10.121
Authors: A Gudipati; M S Uppin; R K Kalidindi; G Swarnalatha; U Das; G Taduri; S B Raju; L Rajasekhar; Aruna K Prayaga Journal: Indian J Nephrol Date: 2017 Sep-Oct