title: Serum Anti-PLA2R Antibody Predicts Treatment Outcome in Idiopathic Membranous Nephropathy.
abstract: BACKGROUND
  M-type phospholipase A2 receptor (PLA2R) has been identified as the major target antigen in idiopathic membranous nephropathy (IMN). However, the role of glomerular PLA2R (gPLA2R) and the associations of serum anti-PLA2R antibody (sPLA2R-Ab) titre with diagnosis, treatment and prognosis in IMN need to be further investigated.
  
  
  METHODS
  We screened 148 consecutive patients with biopsy-proven membranous nephropathy (MN; 113 with IMN and 35 with secondary MN (SMN)) who were followed up for ≤20 months. Serum and urine samples were simultaneously collected at different time points. The levels of sPLA2R-Ab were detected using immunofluorescence and enzyme-linked immunosorbent assay. gPLA2R was assessed by immunofluorescence.
  
  
  RESULTS
  Most patients with IMN displayed both gPLA2R and sPLA2R-Ab positive (85.8 and 82.3%, respectively). In contrast, very few patients with SMN showed either gPLA2R or sPLA2R-Ab positive. The sPLA2R-Ab titre, not gPLA2R, was significantly correlated with proteinuria. Surprisingly, changes in sPLA2R-Ab titre occurred earlier and faster than proteinuria in patients who were followed up for ≤20 months during the whole period of observation. Survival analysis of IMN patients indicated a significant association between sPLA2R-Ab titre and outcome, whereas, no significant difference was observed between the gPLA2R intensity and outcome.
  
  
  CONCLUSIONS
  These data indicate that sPLA2R-Ab might be a better biomarker for IMN diagnosis and treatment outcome. In addition, monitoring sPLA2R-Ab titre may assist in determining when to initiate the administration of immunosuppressive agents and in evaluating treatment efficacy.
authors.affiliation: Department of Nephrology, 2nd Affiliated Hospital of Harbin Medical University, Harbin, PR China.
authors.forename: Shi-Yao
authors.initials: SY
authors.lastname: Wei
authors.forename: Yu-Xiao
authors.initials: YX
authors.lastname: Wang
authors.forename: Jian-Si
authors.initials: JS
authors.lastname: Li
authors.forename: Shi-Lei
authors.initials: SL
authors.lastname: Zhao
authors.forename: Tian-Tian
authors.initials: TT
authors.lastname: Diao
authors.forename: Yu
authors.initials: Y
authors.lastname: Wang
authors.forename: Chang
authors.initials: C
authors.lastname: Wang
authors.forename: Ying
authors.initials: Y
authors.lastname: Qin
authors.forename: Yang
authors.initials: Y
authors.lastname: Cao
authors.forename: Qiuju
authors.initials: Q
authors.lastname: Wei
authors.forename: Bing
authors.initials: B
authors.lastname: Li
mesh_terms: D000328:Adult; D000906:Antibodies / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D005260:Female; D015433:Glomerulonephritis, Membranous / Q000276:immunology* / Q000378:metabolism*; D006801:Humans; D007678:Kidney Glomerulus / Q000737:chemistry*; D008297:Male; D008875:Middle Aged; D054507:Receptors, Phospholipase A2 / Q000032:analysis* / Q000276:immunology*; D015996:Survival Rate
chemical_list: D000906:Antibodies; D015415:Biomarkers; D054507:Receptors, Phospholipase A2