Diagnostic Accuracy Of PLA2R Autoantibody And Staining In Renal Biopsies In Determination Of Primary And Secondary Membranous Nephropathy:An Updated Meta-analysis

Objective Due to the appearance of more reliable well-designed prospective cohort studies with a lot of patients,the value of serum anti-PLA2R and PLA2R glomerular detection as a diagnostic marker of discriminating between idiopathicmembranousnephropathy(IMN)andsecondary membranous nephropathy(SMN)need to be further comprehensively assessed.Methods All available essays about serum anti-PLA2R and/or PLA2R glomerular detection as a marker of discriminating between IMN and SMN which were published from building the databases to July 2017 were pooled from the databases of PubMed,Web of Science,Sciencedirect,Cochrane library,According to a strict including and excluding standard for article screening,papers which finally included in this Meta-analysis would be assessing the quality by QUADAS-2 tool,and data pooled from these papers would be processed and analyzed by two statistical software of Stata and Meta Di Sc.Results A total of 33 essays involving 3105 patients were included in this meta-analysis.The overall sensitivity,specificity,diagnostic odds ratio(DOR),positive likelihood ratio(+LR),negative likelihood ratio(-LR),and area under the receiver operating characteristic curve(AUROC)of serum anti-PLA2R were0.66(95%CI,0.60-0.72),0.98(95%CI,0.92-1.00),97.48(95%CI,22.39-424.53),33.73(95%CI,7.78-146.19),0.35(95%CI,0.29-0.41),0.85(95%CI,0.81-0.88),respectively,with distinct heterogeneity(I~2=95%).Subgroup analyses revealed immunosuppressor therapy and study origin,might account for the heterogeneity.Moreover,the overall sensitivity,specificity,DOR,+LR,-LR and AUROC of PLA2R staining in renal biopsies were 0.78(95%CI,0.72-0.83),0.93(95%CI,0.88-0.96),3.86(95%CI,3.19-4.52),11.17(95%CI,6.20-20.12),0.24(95%CI,0.18-0.31),0.93(95%CI,0.90-0.95),respectively,with obvious heterogeneity(I~2=92%).Subgroup analyses revealed study origin and sample size might account for the heterogeneity.Conclusion Serological anti-PLA2R testing has diagnostic value,with regard to clinical characteristics of patients.when the result is negative,PLA2R staining in renal biopsies is recommended.