THE UNUSAL CASE SERIES OF PLA2R MEMBRANOUS NEPHROPATHY WITH PLA2R ANTIGEN ABSENT AND SERUM PLA2R ANTIBODY PRESENT

Introduction:

Membranous Nephropathy (MN) is the common cause of Nephrotic syndrome in adults. MN is an autoimmune disease with the most prominent antigen being podocyte surface M-type phospholipase A2 Receptor. PLAR2 antigen in glomeruli mostly corresponds to serum anti-PlA2R in primary MN. This phenomenon of hand-in-hand interaction with antigens and antibodies is not always observed. Patients lacking antibodies with glomerular antigens are often described and explained well. Still, the reverse of it, the presence of serum antibodies and the absence of tissue antigens is restricted to a few case reports, case series, or small cohorts. This phenomenon is generally against the known mechanism of pathogenesis of disease

Methods:

We have analyzed MN patients from our database for 2020 to 2021 and found 29 cases of MN by histopathology. Out of which, three patients were secondary MN, and the rest, 26, were found to be primary MN. All 26 patients had serum anti-PLA2R antibodies, and in contrast, 21 patients showed PlA2R antigen positivity in glomeruli on immunohistochemistry, and five patients showed no PLA2R antigen deposit. We evaluate this scenario of antigen absence and antibody presence in these five patients on histopathological, clinical, and management parameters.

Results:

Conclusions:

We conclude that MN with PLA2R antigen negative and AntiPLA2R antibody positive present with chronicity in histopathology, high immunological activity, nonresponder to immunosuppression, and a high risk of progression to Chronic Kidney Disease

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.