title: Temporal IgG Subtype Changes in Recurrent Idiopathic Membranous Nephropathy.
abstract: Determination of the IgG subtypes within the immune deposits in membranous nephropathy (MN) may be helpful in the differential diagnosis. IgG4 is the predominant subtype in idiopathic MN and recurrent MN, while IgG1, IgG2, and IgG3 subtypes are more common in secondary MN and de novo disease in the allograft. The temporal change of IgG subclasses in individual patients and its correlation with clinical variables have not been studied. We reviewed all posttransplantation protocol and indication biopsies (49) in 18 patients with recurrent MN who underwent transplantation at our center between 1998 and 2013 and performed IgG subtyping (IgG1-4). We tested serum for M-type phospholipase A2 receptor (PLA2 R) autoantibodies or performed PLA2 R antigen staining on the kidney biopsy. IgG4 was the (co)dominant IgG subtype in 10 of 14 biopsies at the diagnosis of recurrence regardless of PLA2 R association. In 8 of 12 transplantations with serial biopsies, the (co)dominant subtype did not change over time. There was a trend toward IgG1 and IgG3 (co)dominance in biopsies >1 year from recurrence and more IgG1 (co)dominant subtyping in the setting of more-advanced EM deposits. Treatment with rituximab did not affect the IgG subtype. In conclusion, the dominant IgG subtype did not change over time in recurrent MN.
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
authors.forename: A G
authors.initials: AG
authors.lastname: Kattah
authors.affiliation: Department of Anatomic Pathology, Mayo Clinic, Rochester, MN.
authors.forename: M P
authors.initials: MP
authors.lastname: Alexander
authors.affiliation: Università degli Studi di Cagliari, Sardinia, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Angioi
authors.affiliation: Division of Nephrology, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium.
authors.forename: A S
authors.initials: AS
authors.lastname: De Vriese
authors.affiliation: Department of Anatomic Pathology, Mayo Clinic, Rochester, MN.
authors.forename: S
authors.initials: S
authors.lastname: Sethi
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
authors.forename: F G
authors.initials: FG
authors.lastname: Cosio
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
authors.forename: E C
authors.initials: EC
authors.lastname: Lorenz
authors.affiliation: Department of Anatomic Pathology, Mayo Clinic, Rochester, MN.
authors.forename: L D
authors.initials: LD
authors.lastname: Cornell
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
authors.forename: F C
authors.initials: FC
authors.lastname: Fervenza
mesh_terms: D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000276:immunology; D005260:Female; D015433:Glomerulonephritis, Membranous / Q000276:immunology*; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D014184:Transplantation, Homologous
chemical_list: D001323:Autoantibodies; D007074:Immunoglobulin G
keywords: clinical research/practice; glomerular biology and disease; immune regulation; kidney transplantation/nephrology; pathology/histopathology; recurrent disease