Anti-phospholipase A2 Receptor Antibody in Differentiation and Prognostication of Membranous Nephropathy

• Published in: Saudi journal of kidney diseases and transplantation Vol. 33; no. 2; pp. 280 - 287
• Main Authors: Suthar, Kamlesh S, Vanikar, Aruna V, Patel, Rashmi D, Kanodia, Kamal V, Nigam, Lovelesh A, Gandhi, Paulin A, Mehta, Aanal H
• Format: Journal Article
• Language: English
• Published: Saudi Arabia 01.03.2022
• ISSN: 1319-2442; 2320-3838
• DOI: 10.4103/1319-2442.379026

Anti-M-type phospholipase A receptor (anti-PLA R) antibody is believed to be associated with primary membranous nephropathy (pMN) and absent in secondary MN (sMN). There are few data regarding utility of anti-PLA R antibody as a prognosticator. Our study aimed to compare the incidence of positive serum anti-PLA R antibody titer in pMN versus sMN and correlation with clinical outcome. From August 2015 to July 2019, patients with biopsy-proven MN were evaluated for serum anti-PLA R antibody titers by the enzyme-linked immunosorbent assay. The subset of cases was repeated to monitor the clinical response in terms of 24 h proteinuria. A total of 169 patients, 65 pMN and 104 sMN were studied. Anti-PLA R antibody was found in 41 (63.08%) pMN with mean titer, 232.62 RU/mL, and 40 (38.46%) sMN with mean titer 253.59 RU/mL. Out of positive antiPLA R antibody titer in pMN cases, 15 were retested twice to 5 times with mean titers of 78.95, 36.27, 13.9, and 15.45 RU/mL, respectively. Out of positive anti-PLA R antibody in sMN cases, 11 were retested twice to five times with mean titers of 104.42, 122.49, 12.33, and 17.2 RU/mL, respectively. All patients with decreasing anti-PLA R antibody titer in both groups had clinical remission, with a decrease in mean 24 h proteinuria from 7.11 g to 3.36 g in pMN and 5.97 g to 3.41 g in sMN. Ten pMN and 11 sMN patients without remission showed persistent positive anti- PLA R antibody titer. Anti-PLA R antibody titer may be elevated in pMN/sMN. It can also be used as a noninvasive prognostic marker for MN.