Akademik Veri Yönetim Sistemi
XXXIII. WASPaLM World Congress & XXIV. National Clinicial Biochemistry Congress, Antalya, Türkiye, 16 - 20 Ekim 2024, ss.123, (Özet Bildiri)
Aim: Membranous nephropathy (MN) is a disease in which immune complexes deposit at the glomerular basement membrane, causing damage to the filtration barrier and resulting in proteinuria. It is among the most common causes of nephrotic syndrome in nondiabetic adults. Approximately 80 percent of cases of MN in adults are idiopathic (primary). Secondary MN has been attributed to a variety of causes. In patients who are suspected of having MN, a thorough history is necessary to determine any potential secondary causes. Studies have shown that in the majority of patients with primary MN, the immune complexes consist of autoantibodies against the podocyte protein M-type phospholipase A2 receptor (PLA2R). PLA2R is a type I transmembrane receptor and a member of the mannose-receptor family. This protein is expressed on normal glomerular podocytes and can be present in the glomerular immune deposits in patients with MN. In this study we examined the use of serum PLA2R antibody testing in routine clinical care. Method: Patients that visited Gazi University Hospital around September 2023 and May 2024 were included in this study. Blood was collected in serum tubes with gel seperator and centrifuged at 3500 rpm for 10 minutes. PLA2R antibody concentrations were assessed by enzyme- linked immunosorbent assay (EUROIMMUN AG, Lübeck Germany). Cut-off value for seropositivity recommended by manufacturer is 20 RU/mL. Concentrations between 14 and 19 RU/mL are considered borderline and values below 14 RU/mL can be interpreted as negative. Patients’ baseline data including renal biopsy result, clinical manifestations and serum PLA2R antibody titers were obtained and evaluated. Results: A total of 151 patients and 153 test results were evaluated. 29 patients tested positive for serum PLA2R antibodies (19.2%), 6 patients were considered borderline (3.97%) and 116 patients were seronegative (76.82%). Approximately 9.57% tested negative for serum PLA2R antibodies but had PLA2R antibody positive renal biopsies. 22 of the 29 patients were diagnosed with membranous nephropathy for the first time. Conclusion: Using serum PLA2R antibody testing has helped diagnose 19.2% of patients with membranous nephropathy without the need for a biopsy. Nevertheless, patients with seronegativity will still require a biopsy for confirmation. The need for a biopsy is expected to further decrease by adding more parameters (e.g. Thrombospondin Type-1 Domain containing 7A) and doing additional testing with indirect immuneflorescence assays. More testing is needed to confirm an appropriate and population specific cut-off. Biopsies are invasive procedures that even if uncommon can result in certain complications. Furthermore, it is not as cost effective as blood testing and relatively timeconsuming. The development of blood tests such as PLA2R antibody testing are valuable for effective patient and hospital management, giving the laboratory a critical role.