The Clinical Profile and Long-Term Outcome of Children with Membranous Nephropathy, and the Evaluation of Anti-Phospholipase A2 Receptor Antibody Immunohistochemistry in Kidney Biopsy.

Autor: Deepthi RV; Departments of Child Health, Division of Pediatric Nephrology, Christian Medical College, Vellore, Tamil Nadu, India., George S; Departments of Child Health, Division of Pediatric Nephrology, Christian Medical College, Vellore, Tamil Nadu, India., Mathew G; Departments of Child Health, Division of Pediatric Nephrology, Christian Medical College, Vellore, Tamil Nadu, India., Roy S; Department of General Pathology, Division of Renal Pathology, Christian Medical College, Vellore, Tamil Nadu, India., Bindra M; Consultant in Pathology, Naruvi Hospital, Vellore, Tamil Nadu, India., Rebekah G; Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India., Agarwal I; Departments of Child Health, Division of Pediatric Nephrology, Christian Medical College, Vellore, Tamil Nadu, India.
Jazyk: angličtina
Zdroj: Indian journal of nephrology [Indian J Nephrol] 2023 Nov-Dec; Vol. 33 (6), pp. 432-439. Date of Electronic Publication: 2023 May 03.
DOI: 10.4103/ijn.ijn_228_22
Abstrakt: Introduction: Idiopathic membranous nephropathy (iMN) is a rare cause of nephrotic syndrome in children (1%-7%). Anti-phospholipase A2 receptor (PLA 2 R) antibody positivity in kidney biopsy is observed in 52%-78% of adults and 45% of children with iMN. The objectives of the study are to analyze the clinical profile and outcome of membranous nephropathy in children, to assess the prevalence of anti-PLA 2 R immunohistochemistry (IHC) in kidney biopsy, and to correlate their presence with disease characteristics.
Methods: We are reporting a single-center retrospective study conducted in pediatric nephrology division. Clinical data and outcome parameters of children with membranous nephropathy were analyzed. PLA 2 R IHC was performed in kidney biopsy specimens retrospectively.
Results: We analyzed 43 children with membranous nephropathy (MN) from a single center. 18 (42%) had idiopathic MN (iMN). PLA 2 R IHC was performed in kidney biopsy specimens in 14/18 (78%) patients with iMN and 7/9 (78%) non-lupus secondary membranous nephropathy (SMN) patients. The most common cause of SMN was lupus nephritis in 16 patients (64%). The mean estimated glomerular filtration rate (eGFR) at onset was 156 ± 81 ml/min/1.73m 2 . The sensitivity and specificity of PLA 2 R IHC in diagnosing pediatric MN was 50% and 57%, respectively; positive and negative predictive values were 70% and 36%, respectively. At the final follow-up, chronic kidney disease stage 5 (CKD 5) developed in 2/14 (14.3%) iMN patients.
Conclusions: IHC PLA 2 R staining of glomerular tissue is a useful diagnostic marker of IMN. Though PLA 2 R prevalence is lower in children, its role in guiding treatment needs further exploration.
Competing Interests: There are no conflicts of interest.
(Copyright: © 2023 Indian Journal of Nephrology.)
Databáze: MEDLINE
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