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Clinical and Histological Features of Phospholipase A2 Receptor-Associated and Thrombospondin Type-I Domain-containing 7A-Associated Idiopathic Membranous Nephropathy: A Single Center Retrospective Study from China.
- Source :
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Medical science monitor : international medical journal of experimental and clinical research [Med Sci Monit] 2018 Jul 22; Vol. 24, pp. 5076-5083. Date of Electronic Publication: 2018 Jul 22. - Publication Year :
- 2018
-
Abstract
- BACKGROUND M-type phospholipase A2 receptor (PLA2R) was identified as the major target antigen in idiopathic membranous nephropathy (IMN). Another target antigen, namely thrombospondin type-1 domain-containing 7A (THSD7A), was recently detected in approximately 10% of non-PLA2R-associated IMN. In this single center retrospective study, clinical and histological features of PLA2R-associated and THSD7A-associated IMN patients were evaluated. MATERIAL AND METHODS A total of 192 IMN patients, who were receiving no glucocorticoids or immunosuppressant before renal biopsy, were enrolled in this study and followed for a median duration of 25.5 months. IMN with enhanced glomerular PLA2R and THSD7A staining by immunohistochemistry (IHC) were designated as PLA2R-associated IMN and THSD7A-associated IMN respectively. Serum anti-PLA2R and anti-THSD7A antibodies levels were assessed by enzyme linked immunosorbent assay and indirect immunofluorescence testing in PLA2R-associated and THSD7A-associated IMN. RESULTS Of 192 IMN patients, 164 patients (85.4%) had PLA2R-associated IMN and 3 patients (1.6%) had THSD7A-associated IMN. Compared with non-PLA2R-associated IMN patients, the 24-hour urinary protein levels were significantly higher (P=0.008), whereas, the proteinuria remission rates were significantly lower (P=0.03) in PLA2R-associated IMN patients. No pathological differences were found between PLA2R-associated IMN and non-PLA2R-associated IMN. Among 3 THSD7A-associated IMN patients, 1 patient had elevated serum anti-THSD7A antibody levels, which was below detectable levels after achieving partial proteinuria remission with combined glucocorticoid and cyclosporine treatment. CONCLUSIONS Compared with non-PLA2R-associated IMN patients in our cohort, PLA2R-associated IMN patients presented with more severe proteinuria and lower remission rates after treatment, with no distinct histological differences. Glomerular expression of PLA2R could be a useful marker to indicate the severity, treatment response, and prognosis of IMN.
- Subjects :
- Adult
Aged
Autoantibodies immunology
Biomarkers blood
China
Female
Glomerulonephritis, Membranous blood
Glomerulonephritis, Membranous pathology
Glomerulonephritis, Membranous urine
Humans
Immunohistochemistry
Kidney Glomerulus immunology
Kidney Glomerulus pathology
Male
Middle Aged
Proteinuria immunology
Proteinuria pathology
Retrospective Studies
Glomerulonephritis, Membranous immunology
Receptors, Phospholipase A2 immunology
Thrombospondins immunology
Subjects
Details
- Language :
- English
- ISSN :
- 1643-3750
- Volume :
- 24
- Database :
- MEDLINE
- Journal :
- Medical science monitor : international medical journal of experimental and clinical research
- Publication Type :
- Academic Journal
- Accession number :
- 30032157
- Full Text :
- https://doi.org/10.12659/MSM.909815