Renal Phospholipase A2 Receptor and the Clinical Features of Idiopathic Membranous Nephropathy.
- Author:
Ning-Xin XU
1
;
Qiong-Hong XIE
1
;
Zhu-Xing SUN
2
;
Jia WANG
1
;
Yan LI
1
;
Liang WANG
2
;
Shao-Jun LIU
1
;
Jun XUE
1
;
Chuan-Ming HAO
1
Author Information
- Publication Type:Journal Article
- MeSH: Adult; Autoantibodies; metabolism; Female; Glomerulonephritis, Membranous; drug therapy; metabolism; pathology; urine; Humans; Immunosuppressive Agents; therapeutic use; Kidney; metabolism; pathology; Male; Middle Aged; Receptors, Phospholipase A2; metabolism; Retrospective Studies
- From: Chinese Medical Journal 2017;130(8):892-898
- CountryChina
- Language:English
-
Abstract:
BACKGROUNDAccording 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.
METHODSA 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.
RESULTSOf 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.
CONCLUSIONSThere 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.
