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Abstract: FR-PO813

Discrepancy of Serum Ant-PLA2R and Podocyte PLA2R Expression in Taiwan Patients with Membranous Nephropathy

Session Information

Category: Glomerular Diseases

  • 1202 Glomerular Diseases: Immunology and Inflammation

Authors

  • Tu, Kun-Hua, Chang gung memorial hospital, Taoyuan, Taiwan
  • Wu, Tsai-yi, Chang Gung University, Taoyuan, Taiwan
  • Ku, Cheng-Lung, Chang Gung University, Taoyuan, Taiwan
Background

Anti-phospholipase A2 receptor (PLA2R) autoantibodies could be found in 60~85% patients with idiopathic membranous nephropathy, first discovered in 2009. Enhanced expression of podocyte PLA2R protein in these patients was also postulated later. There are some patients, however, have serum anti-PLA2R antibodies only without enhanced expression of podocyte PLA2R protein, vice versa. Currently, patient with membranous nephropathy have one of each will be diagnosed as PLA2R-associated membranous nephropathy. The mechanism of this discrepancy existing is not clearly known yet. To date, there are few articles reporting prevalence of serum anti-PLA2R and podocyte PLA2R expression in Taiwan patient with membranous nephropathy. We conduct a study to investigate this issue.

Methods

This investigation was prospectively performed in a tertiary hospital. From 2016/8-2018/5 period, patients with biopsy-proved membranous nephropathy will received blood test of plasma anti-PLA2R ELISA (Euroimmune®) before initiation of glucocorticoid or immunosuppressants. In addition, pathologic slides of these patients are proceeded to IHC stain for PLA2R (Atlas®). Clinical parameters and pathologic findings are collected for analyzed.

Results

During the study period, totally 60 patients were diagnosed with membranous nephropathy. 58 patients received blood test for plasma anti-PLA2R, and 55 patients’ pathologic slide were successfully proceeded to IHC stain of podocyte PLA2R. Within patients receiving both evaluation (n=53), there are 24 patients with double positive results (45.3%), and 19 patients with double negative results (35.8%). 3 patients have plasma anti-PLA2R antibody but got negative results of podocyte PLA2R enhanced expression (5.7%). 7 patients have no plasma anti-PLA2R antibody but got positive results of podocyte PLA2R enhanced expression (13.2%). Discrepancy of serum ant-PLA2R and podocyte PLA2R expression account for totally 18.9% of enrolled patients.

Conclusion

The reason of discrepancy of serum ant-PLA2R and podocyte PLA2R expression is still not known yet. Further studies are still needed Currently, serum anti-PLA2R ELSIA assay and tissue IHC stain for PLA2R expression are both useful tools for diagnosis of PLA2R-assocaited membranous nephropathy.