title: Renal Phospholipase A2 Receptor and the Clinical Features of Idiopathic Membranous Nephropathy.
abstract: BACKGROUND
  According to the renal phospholipase A2 receptor (PLA2R) immunohistochemistry, idiopathic membranous nephropathy (iMN) could be categorized into PLA2R-associated and non-PLA2R-associated iMN. This study aimed to examine whether the non-PLA2R-associated iMN had any difference in clinical features compared with PLA2R-associated iMN.
  
  
  METHODS
  A total of 231 adult patients diagnosed as iMN were recruited to this retrospective study. Renal PLA2R expression was examined by immunofluorescence. Among these patients, 186 (80.5%) with complete baseline clinical data were used for further study. Urinary protein excretion, serum albumin, and creatinine were analyzed. For those patients with follow-up longer than 1 year, the relationship between PLA2R and response to immunosuppressants were analyzed. The t-test was used for parametric analysis and the Mann-Whitney U-test was used for nonparametric analysis. Categorical variables were described as frequencies or percentages, and the data were analyzed with Pearson's Chi-square test or Fisher's exact test.
  
  
  RESULTS
  Of the 231 iMN patients, 189 showed renal detectable PLA2R expression (81.8%). The baseline serum creatinine, serum albumin, and urine protein excretion were not significantly different between PLA2R-associated (n = 145) and non-PLA2R-associated iMN patients (n = 41). However, about 1/3 of the non-PLA2R-associated iMN had abnormal serological tests, significantly more common than PLA2R-associated iMN (31.7% vs. 8.3%, P = 0.000). The non-PLA2R-associated iMN had lower C4 levels compared with PLA2R-associated iMN (P = 0.004). The non-PLA2R-associated iMN patients also showed a better response to immunosuppressants (complete remission [CR] 42.9%; partial remission [PR] 14.3%) compared with PLA2R-associated iMN (CR 3.2%; PR 48.4%, P = 0.004) at the 3rd month.
  
  
  CONCLUSIONS
  There were no significant differences in serum creatinine, albumin, and urine protein excretion between PLA2R-associated and non-PLA2R-associated iMN, while the non-PLA2R-associated iMN patients showed more abnormal serological tests. The non-PLA2R-associated iMN seemed to respond more quickly to the immunosuppressive therapy compared with PLA2R-associated iMN.
authors.affiliation: Department of Nephrology, Huashan Hospital, Fudan University, Shanghai 200040, China.
authors.forename: Ning-Xin
authors.initials: NX
authors.lastname: Xu
authors.affiliation: Department of Nephrology, Huashan Hospital, Fudan University, Shanghai 200040, China.
authors.forename: Qiong-Hong
authors.initials: QH
authors.lastname: Xie
authors.affiliation: Department of Nephrology, Wuxi People's Hospital, Wuxi, Jiangsu 214023, China.
authors.forename: Zhu-Xing
authors.initials: ZX
authors.lastname: Sun
authors.affiliation: Department of Nephrology, Huashan Hospital, Fudan University, Shanghai 200040, China.
authors.forename: Jia
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Nephrology, Huashan Hospital, Fudan University, Shanghai 200040, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Nephrology, Wuxi People's Hospital, Wuxi, Jiangsu 214023, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Nephrology, Huashan Hospital, Fudan University, Shanghai 200040, China.
authors.forename: Shao-Jun
authors.initials: SJ
authors.lastname: Liu
authors.affiliation: Department of Nephrology, Huashan Hospital, Fudan University, Shanghai 200040, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Xue
authors.affiliation: Department of Nephrology, Huashan Hospital, Fudan University, Shanghai 200040, China.
authors.forename: Chuan-Ming
authors.initials: CM
authors.lastname: Hao
mesh_terms: D000328:Adult; D001323:Autoantibodies / Q000378:metabolism; D005260:Female; D015433:Glomerulonephritis, Membranous / Q000188:drug therapy / Q000378:metabolism* / Q000473:pathology / Q000652:urine; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000378:metabolism / Q000473:pathology; D008297:Male; D008875:Middle Aged; D054507:Receptors, Phospholipase A2 / Q000378:metabolism*; D012189:Retrospective Studies
chemical_list: D001323:Autoantibodies; D007166:Immunosuppressive Agents; D054507:Receptors, Phospholipase A2