The Expression And Influences On Prognosis Of M-type Phospholipase A2 Receptor And Nephrin In Membranous Nephropathy

Objective: To detect the expression of M-type phospholipase A2 receptor(PLA2R),Nephrin in different types of membranous nephropathy(MN) and in different pathological staging,different prognosis of idiopathic membranous nephropathy(IMN)patients.Combinating with serum anti- PLA2 R detection, further to determine whether there is a correlation between the above each test index in each group and their significance in pathogenesis and prognosis judgement of MN,especially IMN.Methods: 1. The expression and influences on prognosis of M-type phospholipase A2 receptor and nephrin in IMNForty-one patients who were diagnosed as IMN by kidney biopsy in Yantai Yuhuangding Hospital and can regularly return visit between Jan 2012 and July 2013 were collected as experimental group retrospectively. Based on the outcome of proteinuria,they were divided into complete remission group(19 cases), partial remission group(13 cases) and ineffective group(9 cases);Meanwhile,according to their pathological staging,they were also divided into staging I group(18 cases) and staging II group(13 cases),staging Ⅲgroup(10 cases). Ten renal carcinoma patients treated by unilateral nephrectomy were regarded as control group.Clinical and pathological data of all the object of study were collected. The expression of PLA2 R and Nephrin in the kidney tissues of these patients were detected by using immunohistochemical method and analyzed semi-quantitatively by Image pro-plus image analysis system to judge their influences on prognosis.2.The expression of PLA2 R,anti-PLA2 R and Nephrin in different types of MN Thirty-seven patients diagnosed as MN,including 23 patients with IMN,8 patients with HBV-MN and 6 cases with stage V lupus nephritis(LN-V) were collected in this study as experimental group.Ten renal carcinoma patients treated by unilateral nephrectomy were regarded as control group.The expression of PLA2 R and Nephrin in the kidney tissues of these patients were detected by immunohistochemical and semi-quantitated by image analysis system.Enzyme-linked immunoabsorbentassay(ELISA) methods were applied in the detection of serum anti- PLA2 R concentration.Results: 1.The expression and influences on prognosis of M-type phospholipase A2 receptor and nephrin in IMN(1)PLA2R and Nephrin can be seen staining along the glomerular capillary loops both in the experimental group and control group.Compared with the control group,Nephrin expression quantity was general lower(P<0.01) and weaker in continuity in the experimental group.The control group expressed lower PLA2 R than the experimental group(P<0.05).(2)PLA2R relative expression quantity in staging II group is higher than that of staging I group and the control group(P<0.05).Nephrin relative expression quantity in staging I group is higher than that of staging II and III group(P < 0.05).(3)In the experimental group,Nephrin relative expression quantity showed a negative correlation relationship with both the expression of PLA2 R in renal biopsy tissue and urine protein quantitation(P<0.01),but PLA2 R relative expression quantity had no correlation with urine protein quantitation.(4)Renal biopsy pathologic staging was not associated with clinical prognosis(P=0.708).Those who had higher albumin, lower cholesterol and failed to reach NS standard was more likely to get complete remission.The relative quantity of PLA2 R and Nephrin in each prognosis group had no statistical difference(P=0.5; P=0.788). But we can observed when PLA2 R expression quantity was higher, the easier the patient got complete recovery.2.The expression of PLA2R、anti-PLA2 R and Nephrin in different types of MN(1)PLA2R and Nephrin can be seen staining along the glomerular capillary loops both in the experimental group and control group.Compared with the IMN group,PLA2 R expression quantity was significantly lower in the rest of the three group.And there were no statistical difference between the rest of the three groups.Nephrin relative expression quantity in different groups :control group>LN-V> HBV-MN>IMN, the difference were statistically significant.(2)In the IMN group,Nephrin relative expression quantity showed a negative correlation relationship with both the expression of PLA2 R in renal biopsy tissue and serum anti-PLA2 R concentration.PLA2 R relative expression quantity had a positive correlation relationship with serum anti- PLA2 R concentration.(3)All the patients who express positive anti-PLA2 R in the IMN group had an enhanced expression of PLA2 R in kidney tissue.Conclusion:Both of PLA2 R and Nephrin are expressed in the glomerular capillary loops of IMN patients,and their is a negative correlation between their expression quantity. The PLA2 R and Nephrin relative quantity have no obvious correlation with IMN patients’ outcomes. But it sames that patients who have a higher PLA2 R expression are easier to get complete recovery. People can combine the enhanced expression of PLA2 R in renal tissue with the serum anti- PLA2R’ positive expression to distinguish IMN from SMN.What’s more, combination of them with the expression of Nephrin can improve its sensitivity.