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See 1 citation in J Am Soc Nephrol 2017:

J Am Soc Nephrol. 2017 Feb;28(2):421-430. doi: 10.1681/ASN.2016070776. Epub 2016 Oct 24.

A Proposal for a Serology-Based Approach to Membranous Nephropathy.

Author information

1
Division of Nephrology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium; an.devriese@azsintjan.be fervenza.fernando@mayo.edu.
2
Department of Medicine, Geffen School of Medicine, University of California, Los Angeles, California; and.
3
Division of Nephrology and Hypertension and.
4
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
5
Division of Nephrology and Hypertension and an.devriese@azsintjan.be fervenza.fernando@mayo.edu.

Abstract

Primary membranous nephropathy (MN) is an autoimmune disease mainly caused by autoantibodies against the recently discovered podocyte antigens: the M-type phospholipase A2 receptor 1 (PLA2R) and thrombospondin type 1 domain-containing 7A (THSD7A). Assays for quantitative assessment of anti-PLA2R antibodies are commercially available, but a semiquantitative test to detect anti-THSD7A antibodies has been only recently developed. The presence or absence of anti-PLA2R and anti-THSD7A antibodies adds important information to clinical and immunopathologic data in discriminating between primary and secondary MN. Levels of anti-PLA2R antibodies and possibly, anti-THSD7A antibodies tightly correlate with disease activity. Low baseline and decreasing anti-PLA2R antibody levels strongly predict spontaneous remission, thus favoring conservative therapy. Conversely, high baseline or increasing anti-PLA2R antibody levels associate with nephrotic syndrome and progressive loss of kidney function, thereby encouraging prompt initiation of immunosuppressive therapy. Serum anti-PLA2R antibody profiles reliably predict response to therapy, and levels at completion of therapy may forecast long-term outcome. Re-emergence of or increase in antibody titers precedes a clinical relapse. Persistence or reappearance of anti-PLA2R antibodies after kidney transplant predicts development of recurrent disease. We propose that an individualized serology-based approach to MN, used to complement and refine the traditional proteinuria-driven approach, will improve the outcome in this disease.

KEYWORDS:

Immunology and pathology; PLA2R; THSD7A; clinical nephrology; membranous nephropathy

PMID:
27777266
PMCID:
PMC5280030
DOI:
10.1681/ASN.2016070776
[Indexed for MEDLINE]
Free PMC Article

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