H Liu1,2,3, W Luo1,2,3, S Gong1,2,3, X Ding4,5,6. 1. Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China. 2. Shanghai Institute of Kidney and Dialysis, Shanghai, China. 3. Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China. 4. Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China. ding.xiaoqiang@zs-hospital.sh.cn. 5. Shanghai Institute of Kidney and Dialysis, Shanghai, China. ding.xiaoqiang@zs-hospital.sh.cn. 6. Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China. ding.xiaoqiang@zs-hospital.sh.cn.
Abstract
BACKGROUND: Glomerular M-type phospholipase A2 receptor (PLA2 R) is important for diagnosing idiopathic membranous nephropathy (IMN). The relation between glomerular PLA2 R expression and response to treatment remains to be explored. AIMS: We conducted the study to explore the positive rate and clinical significance of glomerular M-type PLA2 R in IMN patients. METHODS: A total of 122 IMN patients receiving neither glucocorticoid nor immunosuppressant therapy prior to renal biopsies was included and followed for more than 1 year. The control group comprised 30 patients with secondary membranous nephropathy and 100 patients with non-membranous forms of nephropathy. PLA2 R level and IgG subclasses in glomeruli were detected. The primary end-point was the reduction of proteinuria to less than 50% of baseline value. RESULTS: A total of 82.0% of patients with IMN had positive glomerular PLA2 R deposits, compared with 16.7% in the secondary membranous nephropathy group (P < 0.001). Additionally, PLA2 R-positive expression combined with IgG4 ≥ 2+ was found in 94.3% IMN patients, compared with 40.0% in secondary membranous nephropathy patients (P < 0.01). Among IMN patients, the remission rate of proteinuria after either glucocorticoid or glucocorticoid combined immunosuppressant therapy for at least 6 months was 83.9% in the PLA2 R-positive group compared with 54.5% in the negative group (P < 0.05). CONCLUSION: The positive rate of glomerular PLA2 R was more prevalent in IMN patients. Both PLA2 R and IgG4 glomerular deposits may help in discriminating between idiopathic and secondary membranous nephropathy. IMN patients with positive PLA2 R expression probably have a more beneficial response to glucocorticoid and/or immunosuppressant therapy.
BACKGROUND: Glomerular M-type phospholipase A2 receptor (PLA2 R) is important for diagnosing idiopathic membranous nephropathy (IMN). The relation between glomerular PLA2 R expression and response to treatment remains to be explored. AIMS: We conducted the study to explore the positive rate and clinical significance of glomerular M-type PLA2 R in IMN patients. METHODS: A total of 122 IMN patients receiving neither glucocorticoid nor immunosuppressant therapy prior to renal biopsies was included and followed for more than 1 year. The control group comprised 30 patients with secondary membranous nephropathy and 100 patients with non-membranous forms of nephropathy. PLA2 R level and IgG subclasses in glomeruli were detected. The primary end-point was the reduction of proteinuria to less than 50% of baseline value. RESULTS: A total of 82.0% of patients with IMN had positive glomerular PLA2 R deposits, compared with 16.7% in the secondary membranous nephropathy group (P < 0.001). Additionally, PLA2 R-positive expression combined with IgG4 ≥ 2+ was found in 94.3% IMN patients, compared with 40.0% in secondary membranous nephropathypatients (P < 0.01). Among IMN patients, the remission rate of proteinuria after either glucocorticoid or glucocorticoid combined immunosuppressant therapy for at least 6 months was 83.9% in the PLA2 R-positive group compared with 54.5% in the negative group (P < 0.05). CONCLUSION: The positive rate of glomerular PLA2 R was more prevalent in IMN patients. Both PLA2 R and IgG4 glomerular deposits may help in discriminating between idiopathic and secondary membranous nephropathy. IMN patients with positive PLA2 R expression probably have a more beneficial response to glucocorticoid and/or immunosuppressant therapy.