Correlation of Anti-Phospholipase A2 Receptor Antibody Level with Disease Activity in Patients with Idiopathic Membranous Nephropathy

Correlation of Anti-Phospholipase A2 Receptor Antibody Level with Disease Activity in Patients with Idiopathic Membranous Nephropathy

Authors

  • Fatima Qayyum Department of Nephrology, KEMU/ Mayo Hospital, Lahore
  • Muhammed Anees Department of Nephrology, KEMU/ Mayo Hospital, Lahore
  • Muhammad Shahbaz Pervaiz Department of Nephrology, KEMU/ Mayo Hospital, Lahore

DOI:

https://doi.org/10.21649/akemu.v31i1.5670

Keywords:

Anti-PLA2R Antibody, Idiopathic Membranous Nephropathy, Proteinuria

Abstract

Background:  Anti phospholipase A2 receptor (PLA2R) antibody detection in serum is a non-invasive, cost effective diagnostic test for idiopathic membranous nephropathy (iMN) precluding the need for a renal biopsy. Extensive research has demonstrated a strong correlation between serum anti-PLA2R antibodies and disease activity but no prior study has been conducted in Pakistan on this important aspect of iMN.

Objective: To ascertain the relationship between anti-PLA2R antibodies and disease activity in patients with biopsy proven iMN.

Methods: This cross sectional study was conducted at Nephrology Department, Mayo Hospital, Lahore from February to October, 2023. Clinical data of individuals with nephrotic syndrome, age >14 years were obtained upon enrollment in the study. Renal biopsy of patients was done and specimen sent for histopathology. The study encompassed eighty-three patients diagnosed with iMN, while the remaining individuals were excluded. Serum levels of anti-PLA2R antibodies of 83 patients with iMN were assessed. 

Results: Out of 83 patients, 51 (61%) tested positive for anti-PLA2R antibody, while 32 (39%) were negative. The mean age of patients was 31.80 ±11.71 years. A significant positive relationship was identified between anti-PLA2R level and 24hour urinary protein (r=0.535, p<0.001), Low density lipoprotein (r=0.357, p<0.05). A significant negative relationship was found between anti-PLA2R level and albumin level (r= -0.440, p<0.001).

Conclusion: Anti-PLA2R antibody levels showed strong correlation with the clinical parameters reflecting the disease activity in iMN. In iMN, the sensitivity of anti-PLA2R antibody was determined to be moderate.

References

1. Keri KC, Blumenthal S, Kulkarni V, Beck L, Chongkrairatanakul T. Primary membranous nephropathy: comprehensive review and historical perspective. Postgrad Med J. 2019;95(1119):23-31. doi:10.1136/postgradmedj-2018-135729.

2. Mubarak M, Kazi JI, Naqvi R, Ahmed E, Akhter F, Naqvi SA et al. Pattern of renal diseases observed in native renal biopsies in adults in a single centre in Pakistan. Nephrol (Carlton). 2011;16(1):87-92. doi:10.1111/j.1440-1797.2010.01410.x.

3. Hashmi MN, Asghar R, Abbasi T, Bashir K, Basharat R, Majeed S. Biopsy-proven Renal Pathologies: Experience from Multan Institute of Kidney Diseases. Saudi J Kidney Dis Transpl. 2020;31(4):850-855. doi:10.4103/1319-2442.292320.

4. Wang M, Yang J, Fang X, Lin W, Yang Y. Membranous nephropathy: pathogenesis and treatments. MedComm (2020). 2024;5(7):614. doi:10.1002/mco2.614.

5. Ronco P, Beck L, Debiec H, Fervenza FC, Hou FF, Jha V et al. Membranous nephropathy. Nat Rev Dis Primers. 2021;7(1):69. doi:10.1038/s41572-021-00303-z.

6. Beck LH Jr, Bonegio RG, Lambeau G, Beck DM, Powell DW, Cummins TD, et al. M-type phospholipase A2 receptor as target antigen in idiopathic membranous nephropathy. N Engl J Med. 2009;361(1):11-21. doi:10.1056/NEJMoa0810457.

7. Ardalan M, Ghafari A, Hamzavi F, Nasri H, Baradaran B, Majidi J et al. Anti-phospholipase A2 receptor antibody in idiopathic membranous nephropathy: A report from Iranian population. J Nephropathol. 2013;2(4):241-8. doi:10.12860/JNP.2013.38.

8. Mukherjee S, Kumar A, Maity P, Sengupta M, Basu K, Chaudhury AR et al. Utility of serum anti-phospholipase A2 receptor antibody as a biomarker in membranous nephropathy: An experience from a tertiary care center of Eastern India. Indian J Pathol Microbiol. 2023;66(2):269-77. doi:10.4103/ijpm.ijpm_210_21.

9. Guo H, Yao Y, Zhou J, Wang S, Wang Y, Zheng D. The cutoff value and prognosis of anti-PLA2R antibody for idiopathic membranous nephropathy: a single-center retrospective study in China. Ren Fail. 2023;45(2):2253922. doi:10.1080/0886022X.2023.2253922.

10. Hofstra JM, Beck LH Jr, Beck DM, Wetzels JF, Salant DJ. Anti-phospholipase A₂ receptor antibodies correlate with clinical status in idiopathic membranous nephropathy. Clin J Am Soc Nephrol. 2011;6(6):1286-91. doi:10.2215/CJN.07210810.

11. Bobart SA, Han H, Tehranian S, De Vriese AS, Roman JCL, Sethi S et al. Noninvasive Diagnosis of PLA2R-Associated Membranous Nephropathy: A Validation Study. Clin J Am Soc Nephrol. 2021;16(12):1833-1839. doi:10.2215/CJN.05480421.

12. Saleem N, Kiani S, Mahmud SN, Haneef M. Anti-Phospholipase A2 Receptor Antibodies in Biopsy-Proven Idiopathic Membranous Nephropathy: A Report from the Pakistani Population. J Coll Physicians Surg Pak. 2022;32(7):950-2. doi:10.29271/jcpsp.2022.07.950.

13. Hihara K, Iyoda M, Tachibana S, Iseri K, Saito T, Yamamoto Y et al. Anti-Phospholipase A2 Receptor (PLA2R) Antibody and Glomerular PLA2R Expression in Japanese Patients with Membranous Nephropathy. PLoS One. 2016;11(6):0158154. doi:10.1371/journal.pone.0158154.

14. Provatopoulou S, Kalavrizioti D, Stangou M, Kouri MN, Kalliakmani P, Papasotiriou M et al. Circulating anti-phospholipase A2 receptor antibodies as a diagnostic and prognostic marker in Greek patients with idiopathic membranous nephropathy - a retrospective cohort study. Rom J Intern Med. 2019; 57(2):141-50. doi:10.2478/rjim-2018-0044.

15. Zhang XD, Lin CX, Cui Z, Gu QH, Yan BJ, Liu L et al. Mapping the T cell epitopes of the M-type transmembrane phospholipase A2 receptor in primary membranous nephropathy. Kidney Int. 2023;103(3):580-92. doi:10.1016/j.kint.2022.11.021.

16. Xie J, Liu L, Mladkova N, Li Y, Ren H, Wang W et al. The genetic architecture of membranous nephropathy and its potential to improve non-invasive diagnosis. Nat Commun. 2020;11(1):1600. doi:10.1038/s41467-020-15383-w.

17. Subramanian P, Kumar H, Tiwari B, Barwad A, Bagchi S, Bagga A et al. Profile of Indian Patients With Membranous Nephropathy. Kidney Int Rep. 2020;5(9):1551-7. doi:10.1016/j.ekir.2020.06.024.

18. Tesar V, Hruskova Z. Autoantibodies in the Diagnosis, Monitoring, and Treatment of Membranous Nephropathy. Front Immunol. 2021;12:593288. doi:10.3389/fimmu.2021.593288.

19. Li YQ, Liu ZZ, Lin KX, Liu RH, Ni L, Liu GX et at. Relationship between the status of phospholipase A2 receptor and prognosis of idiopathic membranous nephropathy. Nephrol (Carlton). 2020;25(2):144-9. doi:10.1111/nep.13625.

20. Chaitanya Gunda K, Mathew GG, Balasubramanian S, Sunil Kumar KS. Clinical implications of serum anti-PLA2R levels and glomerular PLA2R deposits in primary membranous nephropathy. G Ital Nefrol. 2024 ;41(2):1-10. PMID:38695230.

21. Dong L, Li YQ, Guo SM, Xu G, Wei W, Han M. Hypercholesterolemia Correlates With Glomerular Phospholipase A2 Receptor Deposit and Serum Anti-Phospholipase A2 Receptor Antibody and Predicts Proteinuria Outcome in Idiopathic Membranous Nephropathy. Front Immunol. 2022;13(1):905930. doi:10.3389/fimmu.2022.905930.

22. Wang B, Zhu Z, Huang F, Huang H, Tu L, Wang Y et al. Anti-phospholipase A2 receptor antibody levels at diagnosis predicts outcome of TAC-based treatment for idiopathic membranous nephropathy patients. BMC Nephrol. 2022;23(1):306. doi:10.1186/s12882-022-02914-4.

23. Kukuy OL, Cohen R, Gilburd B, Zeruya E, Weinstein T, Agur T et al. The Prognostic Value of Anti-PLA2R Antibodies Levels in Primary Membranous Nephropathy. Int J Mol Sci. 2023;24(10):9051. doi:10.3390/ijms24109051.

Downloads

Published

03/31/2025

How to Cite

Qayyum, F., Muhammed Anees, & Muhammad Shahbaz Pervaiz. (2025). Correlation of Anti-Phospholipase A2 Receptor Antibody Level with Disease Activity in Patients with Idiopathic Membranous Nephropathy. Annals of King Edward Medical University, 31(1), 13–18. https://doi.org/10.21649/akemu.v31i1.5670

Issue

Section

Original Articles

Similar Articles

<< < > >> 

You may also start an advanced similarity search for this article.

Loading...