ArticleBMC nephrology2023
The value of PLA2R antigen and IgG subclass staining relative to anti-PLA2R seropositivity in the differential diagnosis of membranous nephropathy.
Article in BMC nephrology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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13 citing papers in PubMed, 1 synthesis or guideline pooled it, 9 citations in OpenAlex.
- PLA2R autoantibodies, a multifaceted biomarker in nephrotic syndrome and membranous nephropathy.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2025Pooled it
- Serum PLA2R-IgG4/PLA2R-IgG ratio dynamics reveal pathogenic autoantibody subclass switch during progression of PLA2R-associated membranous nephropathy.Annals of medicine · 2026Article
- Diagnostic performance and inter-observer reproducibility of glomerular PLA2R immunohistochemistry in primary membranous nephropathy: a multi-laboratory blinded observer study.BMC nephrology · 2026Article
- The role of serum BAFF, CFB, MCP-1 and anti-PLA2R antibodies in the efficacy evaluation of patients with membranous nephropathy.Journal of medical biochemistry · 2026Article
- PLA2R-Positive Membranous Nephropathy and AA Amyloidosis in an Ethiopian Patient With Chronic Hepatitis B: A Case Report.Clinical case reports · 2026Article
- A noninvasive method of diagnosing membranous nephropathy using exosomes derived from urine.Kidney research and clinical practice · 2026Article
- Treatment strategies for rituximab-resistant primary membranous nephropathy: from resistance mechanisms to emerging therapies.Frontiers in immunology · 2026Review
- From immune dysregulation to renal injury: mechanistic insights and translational opportunities in immune-mediated nephropathies.Frontiers in cell and developmental biology · 2026Review
- Time-resolved fluoroimmunoassay improves sensitivity in the diagnosis of primary membranous nephropathy with low phospholipase A2 receptor antibody titer.Scientific reports · 2025Article
- The Presence of Risk and Protective HLA-DQ Haplotype Combinations and PLA2R1 Risk SNP in Hungarian Patients with Membranous Nephropathy.International journal of molecular sciences · 2025Article
- Questions and Caveats in Antigen-Defined Membranous Nephropathy.Journal of the American Society of Nephrology : JASN · 2025Review
- Membranous nephropathy: pathogenesis and treatments.MedComm · 2024Review
- Membranous nephropathy after multiple Hymenoptera stings: a case report.CEN case reports · 2024Article
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8 authors at 1 institution in 1 country.
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Abstract
backgroundThe diagnostic performance of PLA2R and IgG subclass staining of kidney biopsies relative to anti-PLA2R seropositivity in the differentiation of primary and secondary membranous nephropathy (pMN, sMN) was examined. Besides PLA2R staining - which has a lower specificity than anti-PLA2R antibody serology - there is insufficient knowledge to decide which IgG1-4 subtype immunohistological patterns (IgG4-dominance, IgG4-dominance/IgG1-IgG4-codominance or IgG4-dominance/IgG4-codominance with any IgG subtype) could be used to distinguish between pMN and sMN.
methods87 consecutive Hungarian patients (84 Caucasians, 3 Romas) with the biopsy diagnosis of MN were classified clinically as pMN (n = 63) or sMN (n = 24). The PLA2R and IgG subclass staining was part of the diagnostic protocol. Anti-PLA2R antibodies were determined by an indirect immunofluorescence test in 74 patients with disease activity.
resultsFor pMN, the sensitivity of anti-PLA2R seropositivity was 61.1%, and the specificity was 90.0%; and similar values for PLA2R staining were 81.0%, and 66.7%, respectively. In all stages of pMN, IgG4-dominance was the dominant subclass pattern, while the second most frequent was IgG3/IgG4-codominance. The sensitivity and specificity scores were: IgG4-dominance 52.2% and 91.7%, IgG4-dominance/IgG3-IgG4-codominance 76.2% and 87.5%, IgG4-dominance/IgG1-IgG4-codominance 64.2% and 75%, and IgG4-dominance/codominance with any IgG subclass 92.1% and 70.8%, respectively. Anti-PLA2R seropositivity, glomerular PLA2R, and IgG4-dominance/codominance significantly correlated with each other. The IgG4 subclass was rarely encountered in sMN.
conclusionIn our series, IgG4-dominance had the highest specificity in the differentiation of MN, just as high as that for anti-PLA2R seropositivity. The specificity values of PLA2R staining and IgG4-dominance/codominance with any IgG subclass or IgG4-dominance/IgG1-IgG4 codominance were ≤ 75%. Apart from IgG4 dominance, IgG4-dominance/IgG3-IgG4-codominance also had good statistical value in differentiating pMN from sMN. As IgG subclass switching during the progression of pMN was not the feature of our cohort, pMN in Hungarian patients is presumed to be an IgG4-related disorder right from the start. Although anti-PLA2R seropositivity has become the cornerstone for diagnosing pMN, if a kidney biopsy evaluation is conducted, besides the staining of PLA2R antigen, the evaluation of IgG subclasses provides relevant information for a differential diagnosis. Even in cases with IgG4-dominance, however, malignancy should be thoroughly checked.
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