Anti-phospholipase A2 receptor antibodies in membranous nephropathy and clinical correlation
Other Titles
막성사구체신염 환자에서 antiphospholipase A2 receptor antibodies와 임상상과의 관계
Authors
오윤정
Department
Dept. of Internal Medicine (내과학교실)
Issue Date
2013
Description
Dept. of Medicine/석사
Abstract
Circulating autoantibody to M-type phospholipase A2 receptor (PLA2R) is known as an important pathogenic antibody of idiopathic membranous nephropathy (MN) in adults. However, there has been a discrepancy on relationship between anti-PLA2R and clinical disease activity. Previous studies had several flaws including insufficient study subjects and different time-points and methods for anti-PLA2R measurement. In order to overcome the limitations, I measured anti-PLA2R with western blotting using serum samples obtained at the time of kidney biopsy from relatively large number of MN patients. Anti-PLA2Rs were detected in 69 (69.0%) idiopathic MN patients at initial diagnosis. However, the prevalence of the autoantibodies in patients who entered remission after treatment was lower (15.8%) compared with patients in an initial diagnostic phase. There was a significant correlation between anti-PLA2R reactivity and clinical disease activity. Proteinuria and hypoalbuminemia were more severe in patients with anti-PLA2R than those without the autoantibodies (2.95 g/g vs. 6.85 g/g, P=0.003, 3.1 g/dL vs. 2.5 g/dL, P=0.004). Furthermore, these clinical severities were increased proportionally as anti-PLA2R levels increased (P=0.015 and P for trend<0.001 for proteinuria and hypoalbuminemia, respectively). However, neither presence of anti-PLA2R nor anti-PLA2R levels showed a significant correlation with clinical outcomes including remission rate and time to remission. In conclusion, anti-PLA2R is pathognomonic for idiopathic MN in Korean ethnic group as well, and reflects a clinical disease activity. However, both the presence of anti-PLA2R and the levels of anti-PLA2R cannot predict the clinical outcomes in current clinical practice.