Clinical implications of serum anti-PLA2R levels and glomerular PLA2R deposits in primary membranous nephropathy


Introduction. 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.

  1. Investigate the prevalence of anti PLA2R positivity in PMN.
  2. Ascertain correlation between serum anti-PLA2R levels and glomerular staining for PLA2R with clinical and lab parameters in PMN.

Patients and Methods. 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.
Results. 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.
Conclusion. 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.

Keywords: anti-PLA2R, Membranous Nephropathy, Glomerular PLA2R deposits, Tissue PLA2R staining, Nephrotic Syndrome


Membranous nephropathy (MN) is an important aetiology of adult onset nephrotic syndrome which is subclassified into primary (PMN) and secondary membranous nephropathy. Secondary membranous nephropathy is implicated in clinical scenarios such as cancer, autoimmune diseases and infections [1, 2]. PMN can be diagnosed on the basis of biomarkers like Anti PLA2R levels which can be useful in adjusting the therapeutic initiatives for management of the disease process. These biomarkers may be used to predict clinical consequences like decreased eGFR or proteinuria [3]. The discovery of phospholipase A2 receptor (PLA2R) antibody has contributed to an improvised understanding of the pathophysiology of PMN [4]. The specificity and sensitivity of PLA2R antibody for the PMN has been approximated to be around 100% [5] and 50% to 80% respectively [6]. Previous studies have tried to assess the utility of antibodies to PLA2R in clinical practice. However, there is a definite need for more studies to study the prevalence of glomerular PLA2R deposits, so that it can be applied as a diagnostic and prognostic test in the patients with PMN. 

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