Correlation Of Serum Anti-PLA2R Antibody With Idiopathic Membranous Nephropathy

Background:Idiopathic membranous nephropathy is one of the most commonpathological type of adult nephrotic syndrome, accounting for30%of primary nephroticsyndrome, the clinical manifestations of the disease of varying severity, prognosisdifference, in common in older patients, about10%-40%of patients10years after thedevelopment of end-stage renal disease[1]. Currently, the diagnosis of idiopathicmembranous nephropathy rely solely on renal biopsy examination, and renal biopsypuncture, there are many disadvantages, such as lead perirenal hematoma, infection atthe puncture site, drawing not satisfied with the surgery more expensive, and there issolitary kidney puncture contraindications, leading to the clinical feasibility is limited.Inrecent years, foreign scholars study the pathogenesis of idiopathic membranousnephropathy has made great progress, in2009, Beck et al found M-type phospholipaseA2the receptor (PLA2R), and confirmed for the first time in the kidney PLA2Rtheimportant target antigen of the disease[2], the serum anti PLA2R antibody in patientswith idiopathic membranous nephropathy positive rate of up to70%, while the detectionrate in other non-idiopathic membranous nephropathy in patients with low or negative,the sensitiveand specificity were high, and the method is non-invasive.Objectives:This study was designed on the basis of previous studies to furtherexplore PLA2R and renal function laboratory indicators cysteine protease inhibitor C(Cystainc), blood urea nitrogen (BUN), serum creatinine (CREA), serum uric acid (UA),serumtotal protein (TP), serum albumin (ALB),24-hour urine protein (PRO) in thediagnosis of idiopathic membranous nephropathy and the important role on theevaluation of the disease state.Methods:This study selected46patients who has proved to be idiopathicmembranous nephropathy hospitalized patients that parallel after percutaneous renal biopsy pathology in the Department of Nephrology at the First Affiliated Hospital ofDalian Medical University, and Dalian Central Hospital in February2012-March2013,(31men and15women, average age47.18±13.87years old), Phase I of the23patients (17men and6women, average age46.25±14.18), Phase II in17patients (9men and8women, mean age50.12±16.29)Phase III4patients (3males and1female,average age44.50±8.17), Phase Ⅳ2cases (2men and women, average age53.50±13.26);Non-idiopathic membranous nephropathy in27cases, including six cases ofhepatitis B virus associated membranous nephropathy (2men and4women, mean age39.34±20.11), tumor-associated membranous nephropathy in5patients (4males and1female, mean age57.00±6.17),three cases of lupus membranous nephropathy (0malesand3females, average age37.50±14.33), minimal change glomerulonephritis in5patients (4males and1female, mean age43.25±9.18), IgA nephropathy patients (4men and4female, mean age49.28±10.23). All patients were admitted to hospital forthe first time, there were no hormones and immunosuppressive therapy history.Inaddition, ten cases of healthy subjects (5males and5females, mean age41.2±9.11) asthe control group. All into the group of objects morning fasting serum samples werecollected,3500r/min low-temperature high-speed centrifugation for10min, centrifuge,serum was separated for western blot detection of serum M-type phospholipase A2receptor antibody, for serum Cystain C, BUN, CREA, UA, TP, ALB biochemicalindicators, and detect all the objects and urine PRO content in the24-hour urine.Results：1.46cases of idiopathic membranous nephropathy patients, Western blot detectionof serum anti-PLA2R antibody-positive patients31cases, the positive rate was67.39%,tumor-associated membranous nephropathy were positive, the positive rate of20%, therest are negative.The serum anti-PLA2R antibody detection sensitivity of67.39%,specificity of96.30%2.There was no significant difference compared with the other nephropathylaboratory indicators,but it was different compared with healthy control group.3.There was no significant difference between the serum anti-PLA2R antibodylevels with idiopathic membranous nephropathy pathological stage; Compared with thestage of I-II,III-IV stage of membranous nephropathy (cystatin C Cystainc ureanitrogen BUN, serum creatinine Crea,24-hour urine protein, serum total protein TP,serum albumin ALB) differ, P <0.05,it is significant.4.The serum anti PLA2R antibody levels in the group of idiopathic membranous nephropathy patients with24-hour urine protein was positively correlated(r=0.781**，P=0.00), and serum total protein(r=-0.716**，P=0.00), albumin)r=-0.674**，P=0.00)was negatively correlated.Conclusions: Serum anti-PLA2R antibody can be used as a good indicator of theserological diagnosis of joint detection and renal function-related parameters inidiopathic membranous nephropathy.They play an important role in reflecting diseaseactivity..