Submitted: 04 Apr 2017
Accepted: 08 Aug 2017
First published online: 30 Aug 2017
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J Renal Inj Prev. 2018;7(1):16-21.
doi: 10.15171/jrip.2018.04

Scopus id: 85042628444
  Abstract View: 1061
  PDF Download: 645

Original

Anti-phospholipase A2 receptor antibody in membranous nephropathy; an Indian experience

Monika Yachha, Raj Kumar Sharma * , Sonia Mehrotra, Narayan Prasad, Amit Gupta, Anupma Kaul, Dharmendra Singh Bhadauria

1 Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
*Corresponding author: Professor Raj Kumar Sharma, Email: rksharma@sgpgi.ac.in

Article

Introduction: Autoantibodies against phospholipase-A2 Receptor (PLA2 R), a normally occurring antigen presented on podocyte membranes, have recently been implicated in the pathology of membranous nephropathy (MN).

Objectives: In this observational study, we have evaluated the correlation of patient’s disease activity against serum levels of anti-PLA2 R in patients with primary and secondary MN in a North Indian cohort. Patients and

Methods: We measured serum anti-PLA2 R antibody by ELISA in 63 adult patients with MN. Out of these 63 patients, the majority (58) had primary MN (pMN) and the remaining five had secondary MN (sMN).

Results: Around 55.2% had detectable anti-PLA2 R autoantibodies (63% in those with newonset pMN, 67% in patients with relapse and 3% in patients in remission). However, all patients with refractory pMN (n=4) were anti-PLA2 R negative. There was significantly higher anti-PLA2 R positivity in active stage of disease in contrast to those in remission (P<0.001). Autoantibody level was proportional to the disease activity, with a trend towards significance (P=0.052). Hypoalbuminemia and proteinuria were also significantly worse in the antiPLA2 R positive patients. All patients with sMN tested negative for anti-PLA2 R autoantibodies.

Conclusion: PLA2 R is a major target antigen in Indian population with idiopathic MN. AntiPLA2 R positivity is a specific tool to detect idiopathic MN, and its levels correspond well with other disease activity markers. In addition, anti-PLA2 R antibody was negative in refractory pMN, which suggests the existence of additional autoantibodies in this subgroup, with a different target antigen. These autoantibodies may be resistant to the currently recommended immunosuppressants for the disease, thus the refractory nature of the disease.

Implication for health policy/practice/research/medical education:

In an observational study,a group of patients with membranous nephropathy showed correlation of anti-PLA2R antibodies with disease activity and presence of primary MN.

Please cite this paper as: Yachha M, Sharma RK, Mehrotra S, Prasad N, Gupta A, Kaul A, Bhadauria DS. Anti-phospholipase A2 receptor antibody in membranous nephropathy; an Indian experience. J Renal Inj Prev. 2018;7(1):16-21. DOI: 10.15171/jrip.2018.04.

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