Mukherjee Sriranjan, Kumar Abhishek, Maity Priyanka, Sengupta Moumita, Basu Keya, Chaudhury Arpita Ray, Bandopadhyay Manimoy, Chakraborty Bidhan Chandra
Department of Pathology, IPGMER and SSKM Hospital, Kolkata, West Bengal, India.
Department of Nephrology, IPGMER and SSKM Hospital, Kolkata, West Bengal, India.
Indian J Pathol Microbiol. 2023 Apr-Jun;66(2):269-277. doi: 10.4103/ijpm.ijpm_210_21.
Membranous nephropathy (MN) is a pattern of glomerular injury. Exact categorization into primary membranous nephropathy (PMN) or secondary membranous nephropathy (SMN) is essential for treatment. An endogenous podocyte antigen, M-type phospholipase A2 receptor (PLA2R) has been discovered to be involved in the pathogenesis of PMN.
In this article, we aimed to analyze renal tissue PLA2R and serum anti-PLA2R antibodies in MN cases and determined the diagnostic utility.
The study was of prospective type carried out from March 2019 to August 2020. Analysis of cases of MN was performed with PLA2R paraffin immunoflourescence and serum anti-PLA2R antibody ELISA.
Overall sensitivity, specificity, PPV, and NPV of serum anti-PLA2R ELISA for PMN was 91.3%, 80%, 75%, and 93.3%, respectively, and of tissue PLA2R staining for PMN was 91.67%, 81.08%, 75.86%, and 93.75%, respectively. There was strong concordance between two methods. In the patients that were followed up, we found baseline serum anti-PLA2R antibody was less in complete remission group than that in non-remission group and the reduction in serum anti-PLA2R antibody was more in complete remission group than that in non-remission group.
Routine light and immunofluorescence examination are incapable of giving exact categorical opinion regarding PMN and SMN. Serum anti-PLA2R antibody detection and renal tissue PLA2R analysis are sensitive and specific in detecting PMN. Baseline serum anti-PLA2R antibody and anti-PLA2R antibody quantification trends are related to prognosis of PMN. So they can be incorporated as additional biomarker.
膜性肾病（MN）是一种肾小球损伤模式。准确分类为原发性膜性肾病（PMN）或继发性膜性肾病（SMN）对于治疗至关重要。已发现一种内源性足细胞抗原，M型磷脂酶A2受体（PLA2R）参与PMN的发病机制。
在本文中，我们旨在分析MN病例中的肾组织PLA2R和血清抗PLA2R抗体，并确定其诊断效用。
该研究为前瞻性研究，于2019年3月至2020年8月进行。采用PLA2R石蜡免疫荧光法和血清抗PLA2R抗体ELISA法对MN病例进行分析。
血清抗PLA2R ELISA检测PMN的总体敏感性、特异性、阳性预测值和阴性预测值分别为91.3%、80%、75%和93.3%，肾组织PLA2R染色检测PMN的分别为91.67%、81.08%、75.86%和93.75%。两种方法之间有很强的一致性。在随访的患者中，我们发现完全缓解组的基线血清抗PLA2R抗体低于未缓解组，且完全缓解组血清抗PLA2R抗体的下降幅度大于未缓解组。
常规光镜和免疫荧光检查无法对PMN和SMN给出准确的分类意见。血清抗PLA2R抗体检测和肾组织PLA2R分析在检测PMN方面敏感且特异。基线血清抗PLA2R抗体和抗PLA2R抗体定量趋势与PMN的预后相关。因此，它们可作为额外的生物标志物。
