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Wang T, Wang M, Yu W, Li H, Zhao Z, Shang J. Comparison of performance and clinical utility of different methods for detecting anti-PLA2R antibody. Clin Chim Acta 2023; 548:117514. [PMID: 37567435 DOI: 10.1016/j.cca.2023.117514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/25/2023] [Accepted: 08/08/2023] [Indexed: 08/13/2023]
Abstract
OBJECTIVES This study aimed to compare the performance of enzyme-linked immunosorbent assay (ELISA) and magnetic particle chemiluminescence immunoassay (MP-CLIA) for detecting anti-phospholipase A2 receptor (PLA2R) antibody and their clinical significance in idiopathic membranous nephropathy (IMN) patients. METHODS Serum samples from 448 patients with different types of nephropathy, including 222 with IMN, were tested using both methods. Sensitivity, specificity, and prognostic significance of PLA2R antibody levels were evaluated. RESULTS Similar sensitivity and specificity of ELISA and MP-CLIA in identifying IMN patients was found. However, MP-CLIA performed better than ELISA in predicting the prognosis of IMN patients. Adjusting the cutoff value reduced the false-negative rate in both methods. Logistic regression analysis identified six variables, including MP-CLIA-PLA2R levels, eGFR, lymphocyte count, B lymphocyte count, NK cell count, and complement 4, as predictors of renal function outcomes in IMN patients. CONCLUSIONS Both ELISA and MP-CLIA are reliable methods for detecting anti-PLA2R antibodies in IMN patients. However, MP-CLIA is more accurate in predicting the prognosis of IMN. Combining MP-CLIA-PLA2R with other variables can help predict renal function outcomes in IMN patients. Our study emphasizes the importance of considering both analytical performance and clinical utility when selecting a PLA2R antibody assay kit.
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Affiliation(s)
- Ting Wang
- Department of Nephrology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Zhengzhou University, Zhengzhou, China
| | - Mengxiao Wang
- Department of Nephrology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Zhengzhou University, Zhengzhou, China
| | - Wei Yu
- Department of Nephrology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Zhengzhou University, Zhengzhou, China
| | - Huangmin Li
- Department of Nephrology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Zhengzhou University, Zhengzhou, China
| | - Zhanzheng Zhao
- Department of Nephrology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Nephrology Laboratory, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Laboratory Animal Platform of Academy of Medical Sciences, Zhengzhou University, Zhengzhou, China; Zhengzhou University, Zhengzhou, China.
| | - Jin Shang
- Department of Nephrology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Nephrology Laboratory, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Laboratory Animal Platform of Academy of Medical Sciences, Zhengzhou University, Zhengzhou, China; Zhengzhou University, Zhengzhou, China.
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Chen J, Jia X, Wei X, Li J, Liu Y, Lian Y, Cui Z, Zhao M, Luan S, Zhang M, Mi J, Wang D, Xu D. Optimal Value for Serum Anti-PLA2R Antibody in Primary Membranous Nephropathy: A Multicenter Observational Study. Am J Nephrol 2022; 53:129-138. [PMID: 35272286 DOI: 10.1159/000521836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/31/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Anti-phospholipase A2 receptor antibody (PLA2R-Ab) is highly specific for primary membranous nephropathy (PMN). Here, we compare the diagnostic value of different circulating PLA2R-Ab cutoff titers in multicenter cohorts, with particular focus on determining the optimal cutoff value for Chinese patients. METHODS In total, 288 patients with PMN and 301 with other nephropathies were recruited retrospectively from five hospitals in China between September 2011 and October 2018. PLA2R-Ab in serum obtained at renal biopsy was determined by enzyme-linked immunosorbent assay. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristic (ROC) curve of PLA2R-Ab in diagnosing PMN were assessed. Diagnostic efficiency was evaluated by internal validation. RESULTS The sensitivity, specificity, PPV, NPV, and Youden index for PMN diagnosis were 71%, 90%, 88%, 75%, and 0.61 at the cutoff of 3.8 RU/mL; 74%, 86%, 84%, 76%, and 0.60 at 2.7 RU/mL; 68%, 92%, 90%, 73%, and 0.60 at 5.2 RU/mL; 64%, 95%, 93%, 72%, and 0.59 at 9.0 RU/mL; 57%, 96%, 94%, 68%, and 0.54 at 14.0 RU/mL; 51%, 97%, 95%, 66%, and 0.49 at 20.0 RU/mL; 47%, 98%, 96%, 64%, and 0.45 at 40.0 RU/mL, respectively. The area under the ROC curve was 0.83. CONCLUSION By comprehensively considering specificity and sensitivity, we show that 3.8 RU/mL is the optimal cutoff of PLA2R-Ab in Chinese PMN patients, with a sensitivity of 71% and a specificity of 90%. The cutoff values were 5.2 RU/mL and 9.0 RU/mL when the diagnostic specificity was increased to 92% and 95%, respectively.
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Affiliation(s)
- Juan Chen
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Xiaoyan Jia
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
| | - Xin Wei
- Department of Nephrology, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jiao Li
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Yipeng Liu
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
- Nephrology Research Institute of Shandong Province, Jinan, China
| | - Ying Lian
- Department of Medical Record Management, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Zhao Cui
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
| | - Minghui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
| | - Sen Luan
- Department of Nephrology, Shengli Oilfield Central Hospital, Dongying, China
| | - Minghui Zhang
- Department of Nephrology, Shengli Oilfield Central Hospital, Dongying, China
| | - Jie Mi
- Department of Nephrology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Dongyan Wang
- Department of Nephrology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Dongmei Xu
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
- Nephrology Research Institute of Shandong Province, Jinan, China
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Jurubiță R, Obrișcă B, Achim C, Micu G, Sorohan B, Bobeică R, Vornicu A, Găman M, Căpușă C, Ștefan G, Viașu L, Mircescu G, Ismail G. Anti-phospholipase A2 receptor antibody screening in nephrotic syndrome may identify a distinct subset of patients with primary membranous nephropathy. Int Urol Nephrol 2021; 54:1713-1723. [PMID: 34799809 DOI: 10.1007/s11255-021-03061-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/11/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE We sought to investigate the utility of anti-PLA2R antibody as a non-invasive screening method for the diagnosis of primary MN in patients with nephrotic syndrome (NS). METHODS All consecutive patients with NS admitted in our department, between 01.01.2015 and 31.12.2019 were screened for anti-PLA2R antibodies by an ELISA assay (EUROIMMUN, Lübeck, DE). A positive anti-PLA2R serology was defined as an ELISA value over 2 RU/ml. Subsequently, all patients underwent kidney biopsy to confirm the histological diagnosis. RESULTS Of the 203 patients with NS, we identified 67 patients with "high" titer of anti-PLA2R antibodies (> 20 RU/ml) and 47 patients with "intermediate" titer (2-20 RU/ml). In the entire cohort, the area under the curve (AUC) was 0.83 (95% CI 0.78-0.89; p < 0.001). With a cutoff of 20 RU/ml, the anti-PLA2R antibodies had a 64% sensitivity (95% CI 53-73%) and 94% specificity (95% CI 88-97%) to discriminate MN from other causes of NS. In addition, the PPV and NPV were 91% (95% CI 82-95%) and 75% (95% CI 69-79%). When analyzing the posttest effect, we identified a LR+ of 11.56 (95% CI 5.2-25.2) and LR- of 0.38 (95% CI 0.29-0.5). The overall accuracy of the test was 80.3% (95% CI 74-85%) and the diagnostic odds ratio was 30.42. When performing subgroup analysis, we identified that in younger patients, in those with preserved renal function or with negative workup for secondary causes, the diagnostic performance of anti-PLA2R antibodies was improved, the sensitivity increasing to 68-71%, the PPV to 93-95% and the LR+ to 12.23-15.4. CONCLUSION Serum anti-PLA2R antibody screening in patients with NS is a useful method for the diagnosis of primary MN. In younger patients (less than 60 years old) who have a preserved renal function and a negative workup for secondary causes of NS, a positive anti-PLA2R test highly predicts a diagnosis of primary MN.
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Affiliation(s)
- Roxana Jurubiță
- Department of Nephrology, Fundeni Clinical Institute, Fundeni street 258, 022328, Bucharest, Romania
| | - Bogdan Obrișcă
- Department of Nephrology, Fundeni Clinical Institute, Fundeni street 258, 022328, Bucharest, Romania. .,Department of Nephrology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
| | - Camelia Achim
- Department of Nephrology, Fundeni Clinical Institute, Fundeni street 258, 022328, Bucharest, Romania.,Department of Nephrology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Georgia Micu
- Department of Nephrology, Fundeni Clinical Institute, Fundeni street 258, 022328, Bucharest, Romania
| | - Bogdan Sorohan
- Department of Nephrology, Fundeni Clinical Institute, Fundeni street 258, 022328, Bucharest, Romania.,Department of Nephrology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Raluca Bobeică
- Department of Nephrology, Fundeni Clinical Institute, Fundeni street 258, 022328, Bucharest, Romania
| | - Alexandra Vornicu
- Department of Nephrology, Fundeni Clinical Institute, Fundeni street 258, 022328, Bucharest, Romania
| | - Maria Găman
- Department of Nephrology, Fundeni Clinical Institute, Fundeni street 258, 022328, Bucharest, Romania
| | - Cristina Căpușă
- Department of Nephrology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Nephrology, "Dr. Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania
| | - Gabriel Ștefan
- Department of Nephrology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Nephrology, "Dr. Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania
| | - Liliana Viașu
- Department of Nephrology, "Dr. Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania
| | - Gabriel Mircescu
- Department of Nephrology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Nephrology, "Dr. Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania
| | - Gener Ismail
- Department of Nephrology, Fundeni Clinical Institute, Fundeni street 258, 022328, Bucharest, Romania.,Department of Nephrology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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Porcelli B, Guarnieri A, Ferretti F, Garosi G, Terzuoli L, Cinci F, Tabucchi A, Tampoia M, Abbracciavento L, Villani C, Deleonardi G, Grondona AG, Mazzolini M, La Manna G, Santostefano M, Infantino M, Manfredi M, Spatoliatore G, Rosati A, Somma C, Bizzaro N. Diagnostic accuracy of anti-phospholipase A2 receptor (PLA2R) antibodies in idiopathic membranous nephropathy: an Italian experience. J Nephrol 2020; 34:573-579. [PMID: 33123964 PMCID: PMC8036194 DOI: 10.1007/s40620-020-00888-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 10/10/2020] [Indexed: 11/07/2022]
Abstract
Background Autoantibodies against-phospholipase A2 receptor (PLA2R) are specific markers of idiopathic membranous nephropathy (iMN). Enzyme-linked immunosorbent assay (ELISA) is becoming the preferred method in many laboratories for the determination of anti-PLA2R antibodies, because it provides quantitative results, and is not prone to subjective interpretation, as is the case with indirect immunofluorescence assay. Methods The purpose of our study was to determine the diagnostic performance of serum PLA2R antibodies detected by commercially available ELISA in a large Italian multicenter cohort of patients with biopsy-proven iMN and in patients with other renal diseases, with special focus on evaluating the optimal cut-off value to discriminate positive and negative results. A total of 495 consecutive patients were recruited. Renal biopsies were performed in all patients, and blood samples were taken before the initiation of immunosuppressive treatment. Results According to the clinical diagnosis and to kidney biopsy, 126 patients were diagnosed with iMN and 369 had other non-membranous nephropathies. Anti-PLA2R autoantibodies were detected using a commercial anti-PLA2R ELISA. At a cut-off value of 20 relative units (RU)/ml indicated by the manufacturer for positive classification, sensitivity was 61.1% and specificity 99.7%. At a cut-off value of 14 RU/ml indicated by the manufacturer for borderline results, sensitivity was 63.5% and specificity remained the same (99.7%). At a cut-off of 2.7 RU/ml, selected as the optimal cut-off on the basis of ROC curve analysis, sensitivity was 83.3% and specificity 95.1%. The best overall efficiency of the test was observed at 2.7 RU/ml; however, the highest positive likelihood ratio and diagnostic odds ratio were achieved at 14 RU/ml. A cut-off threshold higher than 14 RU/ml or lower than 2.7 RU/ml entailed worse test performance. Conclusion Depending on the clinical use (early diagnosis or as a support to confirm clinical diagnosis), nephrologists may take advantage of this evidence by choosing the most convenient cut-off. However, renal biopsy remains mandatory for the definitive diagnosis of iMN and for the assessment of disease severity.
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Affiliation(s)
- Brunetta Porcelli
- Dipartimento Biotecnologie Mediche, Sezione Biochimica, Università degli Studi di Siena, Polo Scientifico Universitario San Miniato, Via Alcide De Gasperi 2, 53100, Siena, Italy. .,UOC Laboratorio Patologia Clinica, Policlinico S. Maria Alle Scotte, AOU Senese, Siena, Italy.
| | - Andrea Guarnieri
- UOC Nefrologia, Dialisi e Trapianti, Policlinico S. Maria alle Scotte, AOU Senese, Siena, Italy
| | - Fabio Ferretti
- Dipartimento Scienze Mediche, Chirurgiche e Neuroscienze, Università degli Studi di Siena, Siena, Italy
| | - Guido Garosi
- UOC Nefrologia, Dialisi e Trapianti, Policlinico S. Maria alle Scotte, AOU Senese, Siena, Italy
| | - Lucia Terzuoli
- Dipartimento Biotecnologie Mediche, Sezione Biochimica, Università degli Studi di Siena, Polo Scientifico Universitario San Miniato, Via Alcide De Gasperi 2, 53100, Siena, Italy.,UOC Laboratorio Patologia Clinica, Policlinico S. Maria Alle Scotte, AOU Senese, Siena, Italy
| | - Francesca Cinci
- Dipartimento Biotecnologie Mediche, Sezione Biochimica, Università degli Studi di Siena, Polo Scientifico Universitario San Miniato, Via Alcide De Gasperi 2, 53100, Siena, Italy.,UOC Laboratorio Patologia Clinica, Policlinico S. Maria Alle Scotte, AOU Senese, Siena, Italy
| | - Antonella Tabucchi
- Dipartimento Biotecnologie Mediche, Sezione Biochimica, Università degli Studi di Siena, Polo Scientifico Universitario San Miniato, Via Alcide De Gasperi 2, 53100, Siena, Italy.,UOC Laboratorio Patologia Clinica, Policlinico S. Maria Alle Scotte, AOU Senese, Siena, Italy
| | - Marilina Tampoia
- UOC Patologia Clinica Universitaria, Dipartimento Scienze Biomediche e Oncologia Umana, Azienda Ospedaliero-Universitaria, Policlinico di Bari, Bari, Italy
| | - Letizia Abbracciavento
- UOC Patologia Clinica Universitaria, Dipartimento Scienze Biomediche e Oncologia Umana, Azienda Ospedaliero-Universitaria, Policlinico di Bari, Bari, Italy
| | - Chiara Villani
- UOC Nefrologia Universitaria, Dipartimento dell'Emergenza e dei Trapianti d'Organo, Azienda Ospedaliero-Universitaria, Policlinico di Bari, Bari, Italy
| | - Gaia Deleonardi
- Laboratorio Unico Metropolitano, Ospedale Maggiore, Bologna, Italy
| | | | - Marcello Mazzolini
- Dipartimento Scienze Mediche e Chirurgiche, Università degli Studi di Bologna, Bologna, Italy
| | - Gaetano La Manna
- Dipartimento Medicina Specialistica, Diagnostica e Sperimentale, Università degli Studi di Bologna, Bologna, Italy.,UO Nefrologia, Dialisi e Trapianto, Policlinico Universitario S. Orsola-Malpighi, Bologna, Italy
| | - Marisa Santostefano
- U.O. Nefrologia, Dialisi e Ipertensione, Azienda Ospedaliera-Universitaria Sant'Orsola, Bologna, Italy
| | - Maria Infantino
- Laboratorio Immunologia e Allergologia, Dipartimento di Medicina di Laboratorio, Ospedale San Giovanni di Dio, AUSL Toscana Centro, Firenze, Italy
| | - Mariangela Manfredi
- Laboratorio Immunologia e Allergologia, Dipartimento di Medicina di Laboratorio, Ospedale San Giovanni di Dio, AUSL Toscana Centro, Firenze, Italy
| | - Giuseppe Spatoliatore
- SOC Nefrologia e Dialisi, Ospedale San Giovanni di Dio, AUSL Toscana Centro, Firenze, Italy
| | - Alberto Rosati
- SOC Nefrologia e Dialisi, Ospedale San Giovanni di Dio, AUSL Toscana Centro, Firenze, Italy
| | - Chiara Somma
- SOC Nefrologia e Dialisi, Ospedale Santa Maria Annunziata, AUSL Toscana Centro, Firenze, Italy
| | - Nicola Bizzaro
- Laboratorio di Patologia Clinica, Ospedale San Antonio, Azienda Sanitaria Universitaria Integrata di Udine, Tolmezzo, Italy
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Validation of phospholipase A 2 receptor direct immunofluorescence staining in the diagnosis of primary membranous glomerulonephritis. Pathology 2020; 52:546-551. [PMID: 32564921 DOI: 10.1016/j.pathol.2020.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/30/2020] [Accepted: 04/06/2020] [Indexed: 11/24/2022]
Abstract
Distinguishing between primary and secondary subtypes of membranous glomerulonephritis (MGN) is critical for its clinical management. We prospectively compared direct immunofluorescence (DIF) staining for phospholipase A2 receptor (PLA2R) on frozen renal biopsy with the presence of detectable serum PLA2R antibody assessed by enzyme linked immunosorbent assay (ELISA) in the diagnosis of primary MGN. Forty-six patients with biopsy-proven MGN were enrolled from April 2017 to June 2019 with 31/46 (67.4%) being primary and 15/46 (32.6%) being secondary as determined by comprehensive clinical assessment. This is currently deemed to be the gold standard for distinguishing primary from secondary MGN. Amongst the 31 primary MGN patients, 24/31 were positive on PLA2R DIF staining compared to 18/31 being positive on the PLA2R ELISA (p=0.03). Amongst the 15 secondary MGN patients, 1/15 was positive on PLA2R DIF compared to 0/15 on PLA2R ELISA (p=1.0). In conclusion, the presence of PLA2R staining on DIF demonstrated superior sensitivity and similar specificity compared to the detection of circulating PLA2R antibodies by ELISA in the diagnosis of primary MGN in a cohort of 46 patients with biopsy-proven MGN. We suggest that DIF should be considered as part of routine work-up in all newly diagnosed cases of MGN.
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Wang Q, Dong ZY, Zhang WG, Liu XM, Qu YL, Duan SW, Huang MJ, Zhou JH, Chen P, Zhu HY, Zhang L, Sun XF, Cai GY, Chen XM. Diagnostic efficacy of serum anti-phospholipase A2 receptor antibodies for idiopathic membranous nephropathy in patients with diabetic kidney disease. Clin Chim Acta 2019; 502:222-226. [PMID: 31730818 DOI: 10.1016/j.cca.2019.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/18/2019] [Accepted: 11/04/2019] [Indexed: 01/19/2023]
Abstract
AIM Serum anti-phospholipase A2 receptor (anti-PLA2R) antibodies are highly accurate in diagnosing idiopathic membranous nephropathy (IMN) in populations with kidney disease. However, the diagnostic value of anti-PLA2R antibodies for IMN in diabetic kidney disease (DKD) is unclear. The objective of this study is to determine the diagnostic efficacy and the optimal cut-off value of this marker in populations with DKD. METHODS This study included 227 patients with type 2 diabetes who were admitted to the Department of Nephrology of the Chinese People's Liberation Army General Hospital from May 2016 to January 2018 and underwent pathological diagnosis by renal biopsy. Anti-PLA2R antibodies were detected by enzyme-linked immunosorbent assay in this population. According to the pathological results, the participants were divided into an IMN group and non-membranous nephropathy (non-MN) group. The clinical characteristics were analyzed, the diagnostic ability of anti-PLA2R antibodies was evaluated, and the receiver operating characteristic (ROC) curve was constructed to obtain the optimal cut-off value. RESULTS There were 45 patients in the IMN group, accounting for 19.8% of the study sample. The patients in this group were older at the time of renal biopsy than the non-MN group and presented a shorter duration of diabetes, better glycemic control, lower blood pressure and uric acid, and better renal function; in addition, their clinical symptoms indicated nephrotic syndrome. The optimal cut-off value for anti-PLA2R antibodies for the diagnosis of IMN in DKD was 2.71 Ru/ml, sensitivity was 0.800, specificity was 0.951, positive predictive value was 0.800, negative predictive value was 0.951, accuracy was 0.921, and the Yoden index was 0.750. The area under the ROC curve was 0.87 (95% CI, 0.788-0.952) (p < 0.001). CONCLUSIONS Patients in the IMN group were older, had better renal function and general condition, and the clinical symptoms indicated nephrotic syndrome. Anti-PLA2R antibodies had a good diagnostic performance for IMN in the population with DKD, and the optimal cut-off value was 2.71.
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Affiliation(s)
- Qian Wang
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China
| | - Zhe-Yi Dong
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China
| | - Wei-Guang Zhang
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China
| | - Xiao-Min Liu
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China
| | - Yi-Lun Qu
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China
| | - Shu-Wei Duan
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China
| | - Meng-Jie Huang
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China
| | - Jian-Hui Zhou
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China
| | - Pu Chen
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China
| | - Han-Yu Zhu
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China
| | - Li Zhang
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China
| | - Xue-Feng Sun
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China
| | - Guang-Yan Cai
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China
| | - Xiang-Mei Chen
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China.
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7
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Comparison of measurements of anti-PLA2R antibodies in Japanese patients with membranous nephropathy using in-house and commercial ELISA. Clin Exp Nephrol 2019; 23:465-473. [DOI: 10.1007/s10157-019-01712-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 02/18/2018] [Indexed: 10/27/2022]
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8
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Li W, Zhao Y, Fu P. Diagnostic Test Accuracy of Serum Anti-PLA2R Autoantibodies and Glomerular PLA2R Antigen for Diagnosing Idiopathic Membranous Nephropathy: An Updated Meta-Analysis. Front Med (Lausanne) 2018; 5:101. [PMID: 29755981 PMCID: PMC5932148 DOI: 10.3389/fmed.2018.00101] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 03/28/2018] [Indexed: 02/05/2023] Open
Abstract
Background M-type phospholipase A2 receptor (PLA2R) is known as a major antigen on podocytes, which is involved with the pathogenesis of idiopathic membranous nephropathy (iMN). Many studies have shown that serum anti-PLA2R autoantibodies (sPLA2R) are prevalent in patients with iMN but are rarely detected in secondary membranous nephropathy (SMN) or other glomerulonephritis. The anti-PLA2R is considered as a promising serum biomarker in iMN but reports about its diagnostic value are variable and inconsistent. Objective To evaluate the diagnostic test accuracy (DTA) of anti-PLA2R and glomerular PLA2R antigen (gPLA2R) for diagnosing iMN. Method MEDLINE, EMBASE, WEB OF SCIENCE, and COCHRANE LIBRARY were searched from 2009 January to February 2018. Heterogeneity was evaluated by Q test and I2. Source of heterogeneity was explored by subgroup analysis and meta-regression. Meta-analysis was executed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Results Totally, 35 studies were retrieved under the pre-set study eligibility criteria. Twenty-eight studies were included to evaluate the DTA of anti-PLA2R for differentiating iMN from non-iMN. They indicated a pooled sensitivity of 65% (63–67%), specificity of 97% (97–98%), positive likelihood ratio of 15.65 (9.95–24.62), and negative likelihood ratio of 0.37 (0.32–0.42) with a diagnostic OR (sDOR) of 50.41 (31.56 to 80.52) and AUC of 0.9393. No threshold effect was detected. The heterogeneity analysis for sDOR showed that I2 = 50.3% and Cochran-Q = 54.29, df = 27 (p = 0.0014). Heterogeneity was significant. Meta-regression revealed that sample size might be the potential source of heterogeneity. Subgroup analysis demonstrated that method type and ratio of patients with nephrotic-range proteinuria at baseline might be the source of heterogeneity. Sixteen studies reported the diagnostic value of glomerular PLA2R antigen for differentiating iMN from non-iMN. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, sDOR, and AUC were 79% (76–81%), 90% (88–92%), 8.17 (5.60–11.93), 0.25 (0.19–0.33), 39.37 (22.18–60.13), and 0.9278. Heterogeneity analysis showed that Cochran-Q = 35.36; df = 15 (p = 0.002), and I2 for sDOR was 57.6%. Conclusion sPLA2R and gPLA2R demonstrated a good diagnostic accuracy in differentiating iMN and non-iMN.
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Affiliation(s)
- Weiying Li
- Division of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuliang Zhao
- Division of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ping Fu
- Division of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Liu Y, Li X, Ma C, Wang P, Liu J, Su H, Zhuo H, Kong X, Xu D, Xu D. Serum anti-PLA2R antibody as a diagnostic biomarker of idiopathic membranous nephropathy: The optimal cut-off value for Chinese patients. Clin Chim Acta 2017; 476:9-14. [PMID: 29126817 DOI: 10.1016/j.cca.2017.11.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 11/04/2017] [Accepted: 11/06/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The M-type phospholipase A2 receptor (PLA2R) is a specific target autoantigen identified in idiopathic membranous nephropathy (IMN). The autoantibody against PLA2R (anti-PLA2R) may be used to diagnose IMN. However, the appropriate diagnosis cut-off value for Chinese patients with IMN has not been established. METHODS In total, 119 patients who underwent renal biopsy (57 patients with IMN and 62 patients with non-IMN glomerulonephritis) and 22 healthy individuals were recruited for our observation study from Qianfoshan Hospital between September 2011 and March 2016. The serum concentration of anti-PLA2R was measured using a quantitative enzyme-linked immunosorbent assay (ELISA). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and receiver operating characteristic (ROC) curve of anti-PLA2R in diagnosing IMN were analysed based on the ELISA detection. RESULTS The sensitivity, specificity, PPV, and NPV of anti-PLA2R in the diagnosis of IMN in the Chinese patients were 82.5, 75, 69.1, and 86.3% for the 2RU/ml cut-off value; 78.9, 91.7, 86.5, and 86.5% for the 2.6RU/ml cut-off value; 59.6, 95.2, 89.5, and 77.7% for the 14RU/ml cut-off value; 50.9, 96.4, 90.6, and 74.3% for the 20RU/ml cut-off value; and 47.4, 97.6, 93.1, and 73.2% for the 40RU/ml cut-off value, respectively. The area under the ROC curve was 0.879. CONCLUSIONS The cut-off value of 2.6RU/ml is recommended for the use of anti-PLA2R for the diagnosis of IMN in Chinese patients based on the ELISA.
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Affiliation(s)
- Yipeng Liu
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014, China.
| | - Xuan Li
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014, China
| | - Chaoqun Ma
- Department of Emergency, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250014, China
| | - Ping Wang
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014, China
| | - Ju Liu
- Medical Research Center, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014, China
| | - Hong Su
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014, China
| | - Hao Zhuo
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014, China
| | - Xianglei Kong
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014, China
| | - Dayu Xu
- Department of Nephrology, Zibo Central Hospital, Zibo 255000, China
| | - Dongmei Xu
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014, China.
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