Study On The Expression Of Serum Anti PLA2R Antibody In Idiopathic Membranous Nephropathy

ObjectiveIdiopathic membranous nephropathy(IMN)is one of the main causes of adult primary nephrotic syndrome,although there is a small part of the IMN patients can be relieved,but there are still 1/3 to 1/2 patients gradually progress to end-stage renal disease,the pathogenesis is unknown,the diagnosis and treatment of controversial the prognosis of patients,lead to differences.Since 2009 Beck in the renal tissue of adult patients with IMN were found in the expression of PLA2 R antigen in the blood of patients with IMN at the same time they are first detected anti M phospholipase A2 receptor(M-type phospholipase A2 receptor,PLA2R)autoantibodies.This part of research is to analyze the serum PLA2 R antibody the renal tissue PLA2 R and IgG subtype in idiopathic membranous nephropathy(IMN)in the expression of serum PLA2 R antibody in the diagnosis of idiopathic membranous nephropathy,condition assessment and evaluation of the prognosis of the disease's value.MethodsFrom August 2015-2016 year in March in the nephrology department of the First Affiliated Hospital of Zhengzhou University with biopsy proven idiopathic nephrotic membrane in 61 cases with HBV-MN in 10 cases,8 cases of patients with IgA nephropathy,8 cases of lupus nephritis,8 cases of tumor associated membranous nephropathy,and renal tissue of patients with frozen sections were stained with immunohistochemical staining;Immunofluorescence method was used to observe the expression of idiopathic membranous nephropathy in renal biopsy specimens of PLA2 R and IgG subtype,anti PLA2 R antibodies in sera of patients with the application of the company production of ELISA kit for detection of anti PLA2 R antibody and analyze the correlation between serum PLA2 R antibody and serum albumin and 24 h urine protein Results1.Among the 61 IMN patients,48(80.4%)cases of renal tissue PLA2 R positive serum PLA2 R antibody was positive in 44(72.13%)cases,including 7 cases of serum PLA2 R antibody positive but PLA2 R negative renal tissue,37 cases of serum PLA2 R antibody and PLA2 R in renal tissue were positive;11 cases of renal tissue negative serum antibody positive for PLA2 R,6 the serum PLA2 R antibody and PLA2 R in renal tissue were negative;non IMN nephropathy group only 1 cases of LN-MN,1 cases of anti PLA2 R PLA2R in serum and renal tissue Tumor-MN antibody was positive,the rest were negative.2.IMN patients with renal biopsy results in the positive expression rates of IgG4 was 92.9%,followed by IgG1,IgG2,IgG3,the positive rates were 56.9%,25.3%,17.2%;and the expression of IgG4 and IMN in patients with 24 h urinary protein,serum albumin has a certain relation.3.Correlation analysis showed that the serum anti PLA2 R antibody of the patients in group IMN was negatively correlated with serum albumin,and positively correlated with 24 h urine protein and ESR.Conclusion1.The expression of PLA2 R in renal tissue of IMN patients is not completely consistent with the serum PLA2 R antibody expression and high expression of PLA2 R in serum of patients with anti IMN antibody,serum anti PLA2 R antibody may be IMN specific antibody,and may be used for serological diagnosis of idiopathic membranous nephropathy;anti PLA2 R antibody in the serum and urine of patients with IMN protein,serum albumin there is a correlation between the severity and activity level,suggesting that the content may be related to IMN.2.IMN in patients with glomerular IgG4 deposition with high expression of PLA2 R,while LN-MN and HBV-MN are non IgG4 deposition,and no PLA2 R expression.