Kidney Week

Abstract: PUB458

Comprehensive Analysis of Glomerular Antigens in Membranous Nephropathy

Session Information

• Publication Only

Category: Pathology and Lab Medicine

• 1800 Pathology and Lab Medicine

Authors

• Rina, Isohata, Juntendo Daigaku Igakubu Fuzoku Urayasu Byoin, Urayasu, Chiba, Japan

Isohata Rina

• Suzuki, Hitoshi, Juntendo Daigaku Igakubu Fuzoku Urayasu Byoin, Urayasu, Chiba, Japan

Hitoshi Suzuki, MD, PhD

• Abe, Kenichiro, Juntendo Daigaku Igakubu Fuzoku Urayasu Byoin, Urayasu, Chiba, Japan

Kenichiro Abe, MD

• Lee, Mingfeng, Juntendo Daigaku Igakubu Fuzoku Urayasu Byoin, Urayasu, Chiba, Japan

Mingfeng Lee

• Umezawa, Yukako, Juntendo Daigaku Igakubu Fuzoku Urayasu Byoin, Urayasu, Chiba, Japan

Yukako Umezawa, MD

• Sasatsuki, Yuya, Juntendo Daigaku Igakubu Fuzoku Urayasu Byoin, Urayasu, Chiba, Japan

Yuya Sasatsuki

• Muto, Masahiro, Juntendo Daigaku Igakubu Fuzoku Urayasu Byoin, Urayasu, Chiba, Japan

Masahiro Muto, MD, PhD

• Io, Hiroaki, Juntendo Daigaku Igakubu Daigakuin Igaku Kenkyuka, Bunkyo-ku, Tokyo, Japan

Hiroaki Io, MD, PhD

• Takahara, Hisatsugu, Juntendo Daigaku Igakubu Fuzoku Urayasu Byoin, Urayasu, Chiba, Japan

Hisatsugu Takahara, DrMed

• Tomita, Shigeki, Juntendo Daigaku Igakubu Fuzoku Urayasu Byoin, Urayasu, Chiba, Japan

Shigeki Tomita, MD, PhD

• Suzuki, Yusuke, Juntendo Daigaku Igakubu Daigakuin Igaku Kenkyuka, Bunkyo-ku, Tokyo, Japan

Yusuke Suzuki, MD, PhD

Background

For the diagnosis and treatment of membranous nephropathy (MN), it is essential to determine idiopathic or secondary onset. The phospholipase A2 receptor (PLA2R), thrombospondin type-1 domain-containing 7A (THSD7A), and neural epidermal growth factor-like 1 (NELL-1) have been reported as antigens for MN. Recently, EXT1/EXT2 reported as responsible antigens for secondary membranous nephropathy, however, their significance in diagnosis of each disease type is not clarified.

Methods

We recruited twenty four patients with MN diagnosed at our hospital from 2021 to 2023. We comprehensively analyzed the IgG subclasses on the glomeruli, PLA2R, THSD7A, NELL1, and EXT/EXT2, and verified their significance in the differential diagnosis of idiopathic or secondary MN.

Results

Of the idiopathic MN, 63% were positive for glomerular PLA2R and 16% for THSD7A, and all were negative for NELL-1. Glomerular IgG4 was dominant in 74% of idiopathic MN. On the other hand, in secondary MN, THSD7A was positive in 60% of patients, NELL-1 was positive in all cases, and PLA2R was negative in all cases. Half of the secondary MN caused by autoimmune diseases were positive for EXT1.

Conclusion

Regarding the differential diagnosis between idiopathic and secondary MN, staining with IgG subclass and PLA2R is useful for the diagnosis of idiopathic MN. NELL-1 and EXT1/EXT2 may be useful as markers of secondary MN, however, the further validation of caused antigens of positive for NELL-1 and EXT1/EXT2 is desired.