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2018 ; 2018
(ä): 6281054
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Membranous Nephropathy and Anti-Podocytes Antibodies: Implications for the
Diagnostic Workup and Disease Management
#MMPMID29511687
Pozdzik A
; Brochériou I
; David C
; Touzani F
; Goujon JM
; Wissing KM
Biomed Res Int
2018[]; 2018
(ä): 6281054
PMID29511687
show ga
The discovery of circulating antibodies specific for native podocyte antigens has
transformed the diagnostic workup and greatly improved management of idiopathic
membranous nephropathy (iMN). In addition, their identification has clearly
characterized iMN as a largely autoimmune disorder. Anti-PLA2R1 antibodies are
detected in approximately 70% to 80% and anti-THSD7A antibodies in only 2% of
adult patients with iMN. The presence of anti-THSD7A antibodies is associated
with increased risk of malignancy. The assessment of PLA2R1 and THSD7A antigen
expression in glomerular immune deposits has a better sensitivity than
measurement of the corresponding autoantibodies. Therefore, in the presence of
circulating anti-podocytes autoantibodies and/or enhanced expression of PLA2R1
and THSD7A antigens MN should be considered as primary MN (pMN). Anti-PLA2R1 or
anti-THSD7A autoantibodies have been proposed as biomarkers of autoimmune disease
activity and their blood levels should be regularly monitored in pMN to evaluate
disease activity and predict outcomes. We propose a revised clinical workup flow
for patients with MN that recommends assessment of kidney biopsy for PLA2R1 and
THSD7A antigen expression, screening for circulating anti-podocytes antibodies,
and assessment for secondary causes, especially cancer, in patients with THSD7A
antibodies. Persistence of anti-podocyte antibodies for 6 months or their
increase in association with nephrotic proteinuria should lead to the
introduction of immunosuppressive therapies. Recent data have reported the
efficacy and safety of new specific therapies targeting B cells (anti-CD20
antibodies, inhibitors of proteasome) in pMN which should lead to an update of
currently outdated treatment guidelines.
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