PLA2R Staining is Useful for the Diagnosis and Treatment of Membranous Nephropathy in Pediatric Patients

Abstract

Background: Idiopathic membranous nephropathy (IMN) is a rare disease in children. The incidence is 1.5% in children with nephrotic syndrome. A few studies have also investigated the M-type phospholipase A2 receptor’s (PLA2R) potential role in pediatric IMN, reporting a low positive rate in pediatric kidneys. Objective: Therefore, we conducted immunofluorescence staining using an anti-PLA2R antibody in the renal biopsy specimens of eight pediatric patients with IMN. Methods: We studied the glomerular expression of PLA2R using tissues from children with IMN, and searched for papers on PLA2R staining in pediatric IMN on PubMed. Results and Discussion: Clinical characteristics of patients diagnosed with IMN in this study and the other three studies: A total of 20 pediatric (aged 2–12 years; mean age 7.4 ± 2.8 years) patients and 25 adolescent (aged 13–19 years; mean age 15.9 ± 2.0 years) patients, comprising 25 male (55.6%) and 20 female (44.4%) patients, with 23 (51.1%) patients with IMN being PLA2R-positive, were found to be eligible for this study. Furthermore, we found three papers through our online search. Conclusion: PLA2R expression can be approximately half positive in children with IMN, and it is useful to investigate the causative antigen of PLA2R in children. The intensity of anti-PLA2R antibody expression reflected the disease activity (urinary protein level) of the patients in this study. It is possible to adjust the drug dose in immunosuppressive therapy with reference to the expression intensity of PLA2R.