The optimal anti-phospholipase A2 receptor cutoff for the diagnosis of idiopathic membranous nephropathy: a single-center retrospective study
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Background/Aims: Anti-phospholipase A2 receptor (PLA2R) autoantibody is the main biomarker of idiopathic membranous nephropathy (IMN). We aimed to find a new cutoff value of anti-PLA2R for patients with IMN and to explore the relevance between this antibody and baseline clinical parameters. Methods: A total of 670 subjects including 374 IMN cases and 296 non-IMN controls were included between January 2017 and January 2020. All clinical parameters were collected at the time of renal biopsy. The levels of anti-PLA2R were detected by a commercial enzyme-linked immunosorbent assay (ELISA) kit. The optimal cutoff value was calculated by a receiver operating characteristic curve and compared in diagnostic efficiency. Results: The optimal cutoff value of anti-PLA2R for IMN was 7.45 RU/mL with the highest Youden index, and the corresponding sensitivity, specificity, positive predictive value and negative predictive value were 80.75%, 97.97%, 98.05% and 80.11%, respectively. Anti-PLA2R levels in IMN patients demonstrated a significant positive correlation with serum creatinine and 24-hour urinary protein, while they showed a negative correlation with serum albumin and estimated glomerular filtration rate. Conclusions: The recommended cutoff value of anti-PLA2R is 7.45 RU/mL using ELISA detection for distinguishing IMN from non-IMN nephropathy. The level of anti-PLA2R is related to baseline renal function in IMN. This new threshold can improve the diagnostic efficiency and facilitate early diagnosis of IMN.
Abstract
Background/Aims: Anti-phospholipase A2 receptor (PLA2R) autoantibody is the main biomarker of idiopathic membranous nephropathy (IMN). We aimed to find a new cutoff value of anti-PLA2R for patients with IMN and to explore the relevance between this antibody and baseline clinical parameters. Methods: A total of 670 subjects including 374 IMN cases and 296 non-IMN controls were included between January 2017 and January 2020. All clinical parameters were collected at the time of renal biopsy. The levels of anti-PLA2R were detected by a commercial enzyme-linked immunosorbent assay (ELISA) kit. The optimal cutoff value was calculated by a receiver operating characteristic curve and compared in diagnostic efficiency. Results: The optimal cutoff value of anti-PLA2R for IMN was 7.45 RU/mL with the highest Youden index, and the corresponding sensitivity, specificity, positive predictive value and negative predictive value were 80.75%, 97.97%, 98.05% and 80.11%, respectively. Anti-PLA2R levels in IMN patients demonstrated a significant positive correlation with serum creatinine and 24-hour urinary protein, while they showed a negative correlation with serum albumin and estimated glomerular filtration rate. Conclusions: The recommended cutoff value of anti-PLA2R is 7.45 RU/mL using ELISA detection for distinguishing IMN from non-IMN nephropathy. The level of anti-PLA2R is related to baseline renal function in IMN. This new threshold can improve the diagnostic efficiency and facilitate early diagnosis of IMN.
참고문헌 (31)
- Ponticelli C, "Glomerular diseases : membranous nephropathy : a modern view", Clin J Am Soc Nephrol, 9, pp.609~616 (2014)
- "Chapter 7: Idiopathic membranous nephropathy", Kidney Int Suppl(2011), 2, pp.186~197 (2012)
- Kerjaschki D, "Pathomechanisms and molecular basis of membranous glomerulopathy", Lancet, 364, pp.1194~1196 (2004)
- Obrisca B, "Antiphospholipase A2 receptor autoantibodies : a step forward in the management of primary membranous nephropathy", Biomed Res Int, 2015, pp.249740~ (2015)
- Whittier WL, "Complications of the percutaneous kidney biopsy", Adv Chronic Kidney Dis, 19, pp.179~187 (2012)
- Whittier WL, "Renal biopsy : update", Curr Opin Nephrol Hypertens, 13, pp.661~665 (2004)
- Beck LH Jr, "M-type phospholipase A2 receptor as target antigen in idiopathic membranous nephropathy", N Engl J Med, 361, pp.11~21 (2009)
- Kanigicherla D, "Anti-PLA2R antibodies measured by ELISA predict long-term outcome in a prevalent population of patients with idiopathic membranous nephropathy", Kidney Int, 83, pp.940~948 (2013)
- Behnert A, "Antiphospholipase A2 receptor autoantibodies : a comparison of three different immunoassays for the diagnosis of idiopathic membranous nephropathy", J Immunol Res, 2014, pp.143274~ (2014)
- Luciano RL, "Update on the native kidney biopsy : core curriculum 2019", Am J Kidney Dis, 73, pp.404~415 (2019)
- Levey AS, "A new equation to estimate glomerular filtration rate", Ann Intern Med, 150, pp.604~612 (2009)
- Li J, "Primary glomerular nephropathy among hospitalized patients in a national database in China", Nephrol Dial Transplant, 33, pp.2173~2181 (2018)
- Glassock RJ, "Diagnosis and natural course of membranous nephropathy", Semin Nephrol, 23, pp.324~332 (2003)
- Lai WL, "Membranous nephropathy : a review on the pathogenesis, diagnosis, and treatment", J Formos Med Assoc, 114, pp.102~111 (2015)
- Timmermans SA, "Evaluation of anti-PLA2R1 as measured by a novel ELISA in patients with idiopathic membranous nephropathy : a cohort study", Am J Clin Pathol, 142, pp.29~34 (2014)
- Provatopoulou S, "Circulating anti-phospholipase A2 receptor antibodies as a diagnostic and prognostic marker in Greek patients with idiopathic membranous nephropathy : a retrospective cohort study", Rom J Intern Med, 57, pp.141~150 (2019)
- Hofstra JM, "Antiphospholipase A2receptor antibody titer and subclass in idiopathic membranous nephropathy", J Am Soc Nephrol, 23, pp.1735~1743 (2012)
- Xun C, "Comparison of biomarkers between PLA2RAb+ and PLA2RAb-in patients with idiopathic membranous nephropathy", Int Urol Nephrol, 47, pp.831~835 (2015)
- Li X, "Anti-PLA2R antibodies in Chinese patients with membranous nephropathy", Med Sci Monit, 22, pp.1630~1636 (2016)
- Kim YG, "Anti-phospholipase A2 receptor antibody as prognostic indicator in idiopathic membranous nephropathy", Am J Nephrol, 42, pp.250~257 (2015)
- Katsumata Y, "Clinical usefulness of anti-M-type phospholipase-A-receptor antibodies in patients with membranous nephropathy and the comparison of three quantification methods", Immunol Med, 43, pp.47~56 (2020)
- Hihara K, "Anti-phospholipase A2receptor(PLA2R)antibody and glomerular PLA2R expression in Japanese patients with membranous nephropathy", PLoS One, 11, pp.e0158154~ (2016)
- Dou Y, "The accuracy of the anti-phospholipase A2 receptor antibody in the diagnosis of idiopathic membranous nephropathy : a comparison of different cutoffvalues as measured by the ELISA method", Int Urol Nephrol, 48, pp.845~849 (2016)
- Liu Y, "Serum anti-PLA2R antibody as a diagnostic biomarker of idiopathic membranous nephropathy : the optimal cut-offvalue for Chinese patients", Clin Chim Acta, 476, pp.9~14 (2018)
- Li W, "Comparison of 2 anti-PLA2R immunoassays for the diagnosis of primary membranous nephropathy", Lab Med, 49, pp.316~322 (2018)
- Ramachandran R, "PLA2R antibodies, glomerular PLA2R deposits and variations in PLA2R1 and HLADQA1genes in primary membranous nephropathy in South Asians", Nephrol Dial Transplant, 31, pp.1486~1493 (2016)
- Du Y, "The diagnosis accuracy of PLA2R-AB in the diagnosis of idiopathic membranous nephropathy : a meta-analysis", PLoS One, 9, pp.e104936~ (2014)
- Tomas NM, "Thrombospondin type-1 domain-containing 7A in idiopathic membranous nephropathy", N Engl J Med, 371, pp.2277~2287 (2014)
- Tomas NM, "Autoantibodies against thrombospondin type 1 domain-containing 7A induce membranous nephropathy", J Clin Invest, 126, pp.2519~2532 (2016)
- Wakui H, "Circulating antibodies against alpha-enolase in patients with primary membranous nephropathy(MN)", Clin Exp Immunol, 118, pp.445~450 (1999)
- Bruschi M, "Direct characterization of target podocyte antigens and auto-antibodies in human membranous glomerulonephritis : alfa-enolase and borderline antigens", J Proteomics, 74, pp.2008~2017 (2011)