Anti-phospholipase A2 receptor antibody screening in nephrotic syndrome may identify a distinct subset of patients with primary membranous nephropathy
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 an...
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| Veröffentlicht in: | International urology and nephrology 2022-07, Vol.54 (7), p.1713-1723 |
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| creator | Jurubiță, Roxana Obrișcă, Bogdan Achim, Camelia Micu, Georgia Sorohan, Bogdan Bobeică, Raluca Vornicu, Alexandra Găman, Maria Căpușă, Cristina Ștefan, Gabriel Viașu, Liliana Mircescu, Gabriel Ismail, Gener |
| description | 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
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| doi_str_mv | 10.1007/s11255-021-03061-9 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2600284589</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2600284589</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-a16e40fcf8434881adcf3c60819905e36348859adfa19cc475b1f7f35d10f90b3</originalsourceid><addsrcrecordid>eNp9kc2OFCEUhYnROGPrC7gwJG7clF6KoiiWnYl_ySRudE0o6jLNpAtKoGLqRXxeabv9iQsXhBvOx-GQQ8hzBq8ZgHyTGWuFaKBlDXDoWaMekGsmJG9aMXQP_5qvyJOc7wFADQCPyRXvpKqjuibf96H4ZjnEXNfRLyYj3bc0ocWlxERNlcc4bTTbhBh8uKM-0IDLIcXiLc1bmFKckc5mo37CiruNGjr5XHywheZ1zFhodHQxxVc902--HOiS_GzSRmecx2RCXPPFtWKH7Sl55Mwx47PLviNf3r39fPOhuf30_uPN_raxXIrSGNZjB866oePdMDAzWcdtDwNTCgTy_nQqlJmcYcraToqROem4mBg4BSPfkVdn3yXFryvmomefLR6PJmCNpNseoB06MaiKvvwHvY9rCjVdpWQneilrih1pz5RNMeeETl8-qhnoU2v63JquremfremT9YuL9TrOOP2-8qumCvAzkKsU7jD9efs_tj8AEoKlyw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2674567784</pqid></control><display><type>article</type><title>Anti-phospholipase A2 receptor antibody screening in nephrotic syndrome may identify a distinct subset of patients with primary membranous nephropathy</title><source>SpringerLink Journals - AutoHoldings</source><creator>Jurubiță, Roxana ; Obrișcă, Bogdan ; Achim, Camelia ; Micu, Georgia ; Sorohan, Bogdan ; Bobeică, Raluca ; Vornicu, Alexandra ; Găman, Maria ; Căpușă, Cristina ; Ștefan, Gabriel ; Viașu, Liliana ; Mircescu, Gabriel ; Ismail, Gener</creator><creatorcontrib>Jurubiță, Roxana ; Obrișcă, Bogdan ; Achim, Camelia ; Micu, Georgia ; Sorohan, Bogdan ; Bobeică, Raluca ; Vornicu, Alexandra ; Găman, Maria ; Căpușă, Cristina ; Ștefan, Gabriel ; Viașu, Liliana ; Mircescu, Gabriel ; Ismail, Gener</creatorcontrib><description>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.</description><identifier>ISSN: 1573-2584</identifier><identifier>ISSN: 0301-1623</identifier><identifier>EISSN: 1573-2584</identifier><identifier>DOI: 10.1007/s11255-021-03061-9</identifier><identifier>PMID: 34799809</identifier><language>eng</language><publisher>Dordrecht: Springer Netherlands</publisher><subject>Antibodies ; Biopsy ; Diagnosis ; Enzyme-linked immunosorbent assay ; Kidney diseases ; Medicine ; Medicine & Public Health ; Membranous nephropathy ; Nephrology ; Nephrology - Original Paper ; Nephropathy ; Nephrotic syndrome ; Phospholipase A2 ; Renal function ; Serology ; Urology</subject><ispartof>International urology and nephrology, 2022-07, Vol.54 (7), p.1713-1723</ispartof><rights>The Author(s), under exclusive licence to Springer Nature B.V. 2021</rights><rights>2021. The Author(s), under exclusive licence to Springer Nature B.V.</rights><rights>The Author(s), under exclusive licence to Springer Nature B.V. 2021.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-a16e40fcf8434881adcf3c60819905e36348859adfa19cc475b1f7f35d10f90b3</citedby><cites>FETCH-LOGICAL-c375t-a16e40fcf8434881adcf3c60819905e36348859adfa19cc475b1f7f35d10f90b3</cites><orcidid>0000-0003-4796-4950</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11255-021-03061-9$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11255-021-03061-9$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27923,27924,41487,42556,51318</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34799809$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jurubiță, Roxana</creatorcontrib><creatorcontrib>Obrișcă, Bogdan</creatorcontrib><creatorcontrib>Achim, Camelia</creatorcontrib><creatorcontrib>Micu, Georgia</creatorcontrib><creatorcontrib>Sorohan, Bogdan</creatorcontrib><creatorcontrib>Bobeică, Raluca</creatorcontrib><creatorcontrib>Vornicu, Alexandra</creatorcontrib><creatorcontrib>Găman, Maria</creatorcontrib><creatorcontrib>Căpușă, Cristina</creatorcontrib><creatorcontrib>Ștefan, Gabriel</creatorcontrib><creatorcontrib>Viașu, Liliana</creatorcontrib><creatorcontrib>Mircescu, Gabriel</creatorcontrib><creatorcontrib>Ismail, Gener</creatorcontrib><title>Anti-phospholipase A2 receptor antibody screening in nephrotic syndrome may identify a distinct subset of patients with primary membranous nephropathy</title><title>International urology and nephrology</title><addtitle>Int Urol Nephrol</addtitle><addtitle>Int Urol Nephrol</addtitle><description>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.</description><subject>Antibodies</subject><subject>Biopsy</subject><subject>Diagnosis</subject><subject>Enzyme-linked immunosorbent assay</subject><subject>Kidney diseases</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Membranous nephropathy</subject><subject>Nephrology</subject><subject>Nephrology - Original Paper</subject><subject>Nephropathy</subject><subject>Nephrotic syndrome</subject><subject>Phospholipase A2</subject><subject>Renal function</subject><subject>Serology</subject><subject>Urology</subject><issn>1573-2584</issn><issn>0301-1623</issn><issn>1573-2584</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kc2OFCEUhYnROGPrC7gwJG7clF6KoiiWnYl_ySRudE0o6jLNpAtKoGLqRXxeabv9iQsXhBvOx-GQQ8hzBq8ZgHyTGWuFaKBlDXDoWaMekGsmJG9aMXQP_5qvyJOc7wFADQCPyRXvpKqjuibf96H4ZjnEXNfRLyYj3bc0ocWlxERNlcc4bTTbhBh8uKM-0IDLIcXiLc1bmFKckc5mo37CiruNGjr5XHywheZ1zFhodHQxxVc902--HOiS_GzSRmecx2RCXPPFtWKH7Sl55Mwx47PLviNf3r39fPOhuf30_uPN_raxXIrSGNZjB866oePdMDAzWcdtDwNTCgTy_nQqlJmcYcraToqROem4mBg4BSPfkVdn3yXFryvmomefLR6PJmCNpNseoB06MaiKvvwHvY9rCjVdpWQneilrih1pz5RNMeeETl8-qhnoU2v63JquremfremT9YuL9TrOOP2-8qumCvAzkKsU7jD9efs_tj8AEoKlyw</recordid><startdate>20220701</startdate><enddate>20220701</enddate><creator>Jurubiță, Roxana</creator><creator>Obrișcă, Bogdan</creator><creator>Achim, Camelia</creator><creator>Micu, Georgia</creator><creator>Sorohan, Bogdan</creator><creator>Bobeică, Raluca</creator><creator>Vornicu, Alexandra</creator><creator>Găman, Maria</creator><creator>Căpușă, Cristina</creator><creator>Ștefan, Gabriel</creator><creator>Viașu, Liliana</creator><creator>Mircescu, Gabriel</creator><creator>Ismail, Gener</creator><general>Springer Netherlands</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4796-4950</orcidid></search><sort><creationdate>20220701</creationdate><title>Anti-phospholipase A2 receptor antibody screening in nephrotic syndrome may identify a distinct subset of patients with primary membranous nephropathy</title><author>Jurubiță, Roxana ; Obrișcă, Bogdan ; Achim, Camelia ; Micu, Georgia ; Sorohan, Bogdan ; Bobeică, Raluca ; Vornicu, Alexandra ; Găman, Maria ; Căpușă, Cristina ; Ștefan, Gabriel ; Viașu, Liliana ; Mircescu, Gabriel ; Ismail, Gener</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-a16e40fcf8434881adcf3c60819905e36348859adfa19cc475b1f7f35d10f90b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Antibodies</topic><topic>Biopsy</topic><topic>Diagnosis</topic><topic>Enzyme-linked immunosorbent assay</topic><topic>Kidney diseases</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Membranous nephropathy</topic><topic>Nephrology</topic><topic>Nephrology - Original Paper</topic><topic>Nephropathy</topic><topic>Nephrotic syndrome</topic><topic>Phospholipase A2</topic><topic>Renal function</topic><topic>Serology</topic><topic>Urology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jurubiță, Roxana</creatorcontrib><creatorcontrib>Obrișcă, Bogdan</creatorcontrib><creatorcontrib>Achim, Camelia</creatorcontrib><creatorcontrib>Micu, Georgia</creatorcontrib><creatorcontrib>Sorohan, Bogdan</creatorcontrib><creatorcontrib>Bobeică, Raluca</creatorcontrib><creatorcontrib>Vornicu, Alexandra</creatorcontrib><creatorcontrib>Găman, Maria</creatorcontrib><creatorcontrib>Căpușă, Cristina</creatorcontrib><creatorcontrib>Ștefan, Gabriel</creatorcontrib><creatorcontrib>Viașu, Liliana</creatorcontrib><creatorcontrib>Mircescu, Gabriel</creatorcontrib><creatorcontrib>Ismail, Gener</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>International urology and nephrology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jurubiță, Roxana</au><au>Obrișcă, Bogdan</au><au>Achim, Camelia</au><au>Micu, Georgia</au><au>Sorohan, Bogdan</au><au>Bobeică, Raluca</au><au>Vornicu, Alexandra</au><au>Găman, Maria</au><au>Căpușă, Cristina</au><au>Ștefan, Gabriel</au><au>Viașu, Liliana</au><au>Mircescu, Gabriel</au><au>Ismail, Gener</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Anti-phospholipase A2 receptor antibody screening in nephrotic syndrome may identify a distinct subset of patients with primary membranous nephropathy</atitle><jtitle>International urology and nephrology</jtitle><stitle>Int Urol Nephrol</stitle><addtitle>Int Urol Nephrol</addtitle><date>2022-07-01</date><risdate>2022</risdate><volume>54</volume><issue>7</issue><spage>1713</spage><epage>1723</epage><pages>1713-1723</pages><issn>1573-2584</issn><issn>0301-1623</issn><eissn>1573-2584</eissn><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.</abstract><cop>Dordrecht</cop><pub>Springer Netherlands</pub><pmid>34799809</pmid><doi>10.1007/s11255-021-03061-9</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0003-4796-4950</orcidid></addata></record> |
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| ispartof | International urology and nephrology, 2022-07, Vol.54 (7), p.1713-1723 |
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| subjects | Antibodies Biopsy Diagnosis Enzyme-linked immunosorbent assay Kidney diseases Medicine Medicine & Public Health Membranous nephropathy Nephrology Nephrology - Original Paper Nephropathy Nephrotic syndrome Phospholipase A2 Renal function Serology Urology |
| title | Anti-phospholipase A2 receptor antibody screening in nephrotic syndrome may identify a distinct subset of patients with primary membranous nephropathy |
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