title: Detection and clinical significance of glomerular M-type phospholipase A2receptor in patients with idiopathic membranous nephropathy.
abstract: BACKGROUND
  Glomerular M-type phospholipase A2receptor (PLA2R) is important for diagnosing idiopathic membranous nephropathy (IMN). The relation between glomerular PLA2R expression and response to treatment remains to be explored.
  
  
  OBJECTIVE
  We conducted the study to explore the positive rate and clinical significance of glomerular M-type PLA2R in IMN patients.
  
  
  METHODS
  A total of 122 IMN patients receiving neither glucocorticoid nor immunosuppressant therapy prior to renal biopsies was included and followed for more than 1 year. The control group comprised 30 patients with secondary membranous nephropathy and 100 patients with non-membranous forms of nephropathy. PLA2R level and IgG subclasses in glomeruli were detected. The primary end-point was the reduction of proteinuria to less than 50% of baseline value.
  
  
  RESULTS
  A total of 82.0% of patients with IMN had positive glomerular PLA2R deposits, compared with 16.7% in the secondary membranous nephropathy group (P < 0.001). Additionally, PLA2R-positive expression combined with IgG4 ≥ 2+ was found in 94.3% IMN patients, compared with 40.0% in secondary membranous nephropathy patients (P < 0.01). Among IMN patients, the remission rate of proteinuria after either glucocorticoid or glucocorticoid combined immunosuppressant therapy for at least 6 months was 83.9% in the PLA2R-positive group compared with 54.5% in the negative group (P < 0.05).
  
  
  CONCLUSIONS
  The positive rate of glomerular PLA2R was more prevalent in IMN patients. Both PLA2R and IgG4 glomerular deposits may help in discriminating between idiopathic and secondary membranous nephropathy. IMN patients with positive PLA2R expression probably have a more beneficial response to glucocorticoid and/or immunosuppressant therapy.
authors.affiliation: Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.|Shanghai Institute of Kidney and Dialysis, Shanghai, China.|Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China.
authors.forename: H
authors.initials: H
authors.lastname: Liu
authors.affiliation: Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.|Shanghai Institute of Kidney and Dialysis, Shanghai, China.|Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China.
authors.forename: W
authors.initials: W
authors.lastname: Luo
authors.affiliation: Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.|Shanghai Institute of Kidney and Dialysis, Shanghai, China.|Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China.
authors.forename: S
authors.initials: S
authors.lastname: Gong
authors.affiliation: Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China. ding.xiaoqiang@zs-hospital.sh.cn.|Shanghai Institute of Kidney and Dialysis, Shanghai, China. ding.xiaoqiang@zs-hospital.sh.cn.|Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China. ding.xiaoqiang@zs-hospital.sh.cn.
authors.forename: X
authors.initials: X
authors.lastname: Ding
mesh_terms: D000328:Adult; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001323:Autoantibodies / Q000097:blood*; D015415:Biomarkers; D001706:Biopsy; D002681:China; D005260:Female; D015433:Glomerulonephritis, Membranous / Q000175:diagnosis* / Q000188:drug therapy*; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D007678:Kidney Glomerulus / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000188:drug therapy; D054507:Receptors, Phospholipase A2 / Q000032:analysis* / Q000276:immunology; D012189:Retrospective Studies
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D001323:Autoantibodies; D015415:Biomarkers; D005938:Glucocorticoids; D007074:Immunoglobulin G; D054507:Receptors, Phospholipase A2
keywords: idiopathic and secondary membranous nephropathy; phospholipase A2
   receptor; proteinuria