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2016 ; 68
(1
): 138-47
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Membranous Nephropathy: A Journey From Bench to Bedside
#MMPMID27085376
Francis JM
; Beck LH Jr
; Salant DJ
Am J Kidney Dis
2016[Jul]; 68
(1
): 138-47
PMID27085376
show ga
Lessons from an animal model that faithfully resembles human membranous
nephropathy (MN) have informed our understanding of the pathogenesis of this
organ-specific autoimmune disease and common cause of nephrotic syndrome. After
it was established that the subepithelial immune deposits that characterize
experimental MN form in situ when circulating antibodies bind to an intrinsic
podocyte antigen, it was merely a matter of time before the human antigen was
identified. The M-type phospholipase A2 receptor 1 (PLA2R) represents the major
target antigen in primary MN, and thrombospondin type 1 domain-containing 7A
(THSD7A) was more recently identified as a minor antigen. Serologic tests for
anti-PLA2R and kidney biopsy specimen staining for PLA2R show >90% specificity
and 70% to 80% sensitivity for the diagnosis of primary MN in most populations.
The assays distinguish most cases of primary MN from MN associated with other
systemic diseases, and sequential anti-PLA2R titers are useful to monitor
treatment response. A positive pretransplantation test result for anti-PLA2R is
also helpful for predicting the risk for posttransplantation recurrence.
Identification of target epitopes within PLA2R and the genetic association of
primary MN with class II major histocompatibility and PLA2R1 variants are 2
additional examples of our evolving understanding of this disease.