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Abstract: PO1475

Can the Use of the Serum Anti-PLA2R Antibody Negate the Need for a Renal Biopsy in Primary Membranous Nephropathy?

Session Information

Category: Glomerular Diseases

  • 1202 Glomerular Diseases: Immunology and Inflammation

Authors

  • Ragy, Omar Sherin, Manchester Metropolitan University, Manchester, Greater Manchester, United Kingdom
  • Rautemaa, Vilma, Manchester Metropolitan University, Manchester, Greater Manchester, United Kingdom
  • Kanigicherla, Durga Anil K, Manchester Metropolitan University, Manchester, Greater Manchester, United Kingdom
  • Hamilton, Patrick, Manchester Metropolitan University, Manchester, Greater Manchester, United Kingdom
Background

Since the emergence of the anti-PLA2R antibody test, nephrology practice has not changed dramatically, and most nephrologists are still relying on performing a kidney biopsy in diagnosing membranous nephropathy. In this study, we sought to examine how anti-PLA2R antibody tests using ELISA can be utilized in clinical practice.

Methods

We have conducted a retrospective analysis for 187 patients between 2003 and 2020 correlating their renal biopsy findings with their anti-PLA2R antibody test when performed. We have recorded all patient’s demography, urine protein creatinine ratios, serum albumin, and treatment commenced whether using RAS blockade or immunosuppression treatment.
Using a statistical analysis model, we have calculated the positive and negative predictive values of the anti-PLA2R ab test carried out during that period.

Results

The mean levels of anti-PLA2R antibody titer in primary membranous nephropathy were 217 RU/ml, whereas the mean level was only 3 RU/ml for both secondary membranous nephropathy and other diagnoses. The majority of our cohort who had a positive anti-PLA2R antibody test had a confirmed renal biopsy diagnosis of primary membranous nephropathy with a PPV of 97.3%. Also, we found that the test sensitivity was 75.5%. On the other hand, we found that the NPV was 79.8% and the specificity was 97.8% at a level of >20 RU/ml

Conclusion

The anti-PLA2R antibody test is a highly specific test for diagnosing membranous nephropathy. Experience from our center supported by some evidence from the literature suggests that we can rely solely on a positive test without the need to perform a renal biopsy. More prospective trials are required to further validate that notion.

Funding

  • Private Foundation Support