Chaitanya Gunda Krishna, Mathew Gerry George, Balasubramanian S, Sunil Kumar K S
MD, DNB(Nephrology) Consultant Nephrologist, Department of Nephrology, Asian institute of Nephrology and Urology, Nungambakkam, Chennai, Tamil Nadu, India-600034.
MD, DNB(Nephrology) Associate Professor, Department of Nephrology, SRM Medical College Hospital and Research Centre, Kattankulathur, Tamil Nadu, India-603203.
G Ital Nefrol. 2024 Apr 29;41(2):2024-vol2.
The clinical implications of serum anti-PLA2R with glomerular PLA2R deposits in primary membranous nephropathy (PMN) is scarcely reported. Hence the study was designed to demonstrate the prevalence of serum anti-PLA2R levels and PLA2R staining in glomeruli in PMN and the clinical implications of the two parameters. Investigate the prevalence of anti PLA2R positivity in PMN. Ascertain correlation between serum anti-PLA2R levels and glomerular staining for PLA2R with clinical and lab parameters in PMN. Fifty PMN patients during the period from October 2017 to December 2018 were included. Labs were done and eGFR was calculated as per MDRD 6. Anti-PLA2R titres were done in all patients. Titres more than 20 RU/ml were considered positive. Glomerular staining for PLA2R was graded on fresh frozen tissue by immunofluorescence technique. Anti-PLA2R antibody positivity and glomerular PLA2R deposition was observed in 42% (21/50) and 86% (43/50) patients respectively. 79.3% (23/29) had positive glomerular PLA2R deposition with negative serum anti PLA2R. Positive correlation were observed between serum PLA2R antibody and serum creatinine (p = 0.0001) and urine protein-creatinine ratio levels with tissue PLA2R staining grades (p = 0.04). Negative association was found between serum albumin (p = 0.026) and tissue PLA2R staining grades. Serum anti-PLA2R wasn't a sensitive marker of primary membranous nephropathy in our study group emphasising the need to consider a compendium of serological markers for diagnosis of primary membranous nephropathy and to rely more on glomerular deposition of PLA2R as a better clinical indicator for PMN.
原发性膜性肾病（PMN）中血清抗磷脂酶A2受体（anti-PLA2R）与肾小球磷脂酶A2受体（PLA2R）沉积的临床意义鲜有报道。因此，本研究旨在阐明PMN患者血清抗PLA2R水平及肾小球PLA2R染色的发生率，以及这两个参数的临床意义。调查PMN中抗PLA2R阳性的发生率。确定PMN患者血清抗PLA2R水平与肾小球PLA2R染色之间以及与临床和实验室参数之间的相关性。纳入2017年10月至2018年12月期间的50例PMN患者。进行实验室检查，并根据MDRD 6计算估算肾小球滤过率（eGFR）。对所有患者检测抗PLA2R滴度。滴度超过20 RU/ml被视为阳性。通过免疫荧光技术对新鲜冰冻组织上的PLA2R进行肾小球染色分级。分别在42%（21/50）和86%（43/50）的患者中观察到抗PLA2R抗体阳性和肾小球PLA2R沉积。79.3%（23/29）的患者肾小球PLA2R沉积阳性但血清抗PLA2R阴性。观察到血清PLA2R抗体与血清肌酐之间呈正相关（p = 0.0001），尿蛋白-肌酐比值水平与组织PLA2R染色分级之间呈正相关（p = 0.04）。血清白蛋白与组织PLA2R染色分级之间呈负相关（p = 0.026）。在我们的研究组中，血清抗PLA2R不是原发性膜性肾病的敏感标志物，这强调了在原发性膜性肾病诊断中需要考虑一系列血清学标志物，并更多地依赖PLA2R的肾小球沉积作为PMN更好的临床指标。
