Can we manage without biopsy in membranous nephropathy with positive anti-PLA2R antibodies?

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"tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "311" "paginaFinal" => "312" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Lara Ruiz Martínez, Gema Fernández Fresnedo, Emilio Rodrigo, Milagros Heras" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Lara" "apellidos" => "Ruiz Martínez" "email" => array:1 [ 0 => "lararuizmartinez@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Gema" "apellidos" => "Fernández Fresnedo" ] 2 => array:2 [ "nombre" => "Emilio" "apellidos" => "Rodrigo" ] 3 => array:2 [ "nombre" => "Milagros" "apellidos" => "Heras" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Podemos prescindir de la biopsia renal en la nefropatía membranosa en caso de anticuerpos anti-PLA2R positivos?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1169 "Ancho" => 1669 "Tamanyo" => 167010 ] ] "descripcion" => array:1 [ "en" => "Evolution of renal function, proteinuria and its immunological marker (anti-PLA2R antibody) after immunosuppressive treatment." ] ] ] "textoCompleto" => "We present the case of a 71-year-old man, hypertensive, with a 3 weeks history of edema on the eyelids and lower limbs. The following data were observed: Hematology: leukocytes: 11,700×103μm−1; hemoglobin: 12.2g/dl, and platelets: 36,900×103μm−1. Biochemical profile: creatinine: 1.2mg/dl; glomerular filtration rate (CKD-EPI): 60.2ml/min; cholesterol: 325mg/dl; HDL: 56mg/dl; LDL: 238mg/dl, and calcium: 10.2mq/dl. In 24h urine: proteinuria: 13,530mg with microhematuria. Immunology w/u without hypocomplementemia, mild decrease in immunoglobulin G. Rheumatoid factor, anti-nuclear antibodies, anti-neutrophil cytoplasm antibodies, anti-glomerular basement membrane antibodies were negative and there were positive only the anti-PLA2r antibodies 1/160. In the ultrasound study: normal kidneys without vascular or parenchymal damage, ruling out obstruction. The study of possible secondary causes with serologies of hepatitis B, C and HIV negative viruses, chest X-ray and abdominal ultrasound without data suggestive of neoplasia, echocardiogram without data of endocarditis and Bence-Jones proteinuria negative was completed. It was decided to perform a renal biopsy, but the previous day began with dry cough, dyspnea and desaturation (90%), so a lung scan was performed in which pulmonary thromboembolism was observed, anticoagulation was started and no renal biopsy could be performed. With these data and given the positivity of M-type phospholipase A2 receptor antibodies (anti-PLA2R), a diagnosis of possible membranous nephropathy was made and empirical treatment was decided with corticosteroids and oral cyclophosphamide with favorable response of the nephrotic syndrome and complete remission (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Primary membranous nephropathy, a frequent cause of nephrotic syndrome, is an antibody-mediated glomerular disease. Since 2009, in which Beck discovered the antigen involved, PLA2R, there have been multiple advances on the of diagnostic value and predictive power of PLA2R.<a class="elsevierStyleCrossRefs" href="#bib0055">1,2</a> Anti-PLA2R antibodies are present in 70–80% of primary membranous nephropathies (in podocytes, formed in situ together with IgG),<a class="elsevierStyleCrossRefs" href="#bib0055">1,3</a> in a 5–10% of cases there is another antibody involved, thrombospondin (THSD7A), and in the rest of patients the causal antibody remains to be identified.<a class="elsevierStyleCrossRef" href="#bib0070">4</a>The presence of anti-PLA2R antibodies has a sensitivity higher than 70%, and a specificity of almost 100% for the diagnosis of membranous nephropathy.<a class="elsevierStyleCrossRefs" href="#bib0070">4–6</a> The severity of the disease is associated to higher level of AB, with greater proteinuria and less possibility of spontaneous remission.<a class="elsevierStyleCrossRefs" href="#bib0060">2,7–10</a> In addition, the level of anti-PLA2R antibodies may serve as a biological marker, since the immune response precedes the appearance of proteinuria and the reduction of antibodies is often seen before the resolution of proteinuria.<a class="elsevierStyleCrossRefs" href="#bib0055">1,2,4,6,8–10</a> Thus, the presence of anti-PLA2R antibodies in serum has been considered a signal of active disease suggesting early immunosuppressive treatment without the need to complete the 6 months of support treatment.<a class="elsevierStyleCrossRefs" href="#bib0070">4–10</a> The high specificity of these antibodies has already posed the possibility of assuming an accurate diagnosis and especially in those cases, such as ours, in which there is a very high or unacceptable risk of performing a renal biopsy.<a class="elsevierStyleCrossRefs" href="#bib0070">4,6,7</a>Finally, in terms of treatment, good results have always been obtained with the combination of corticosteroids and cyclophosphamide." 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Beck Jr." 1 => "R.G. Bonegio" 2 => "G. Lambeau" 3 => "D.M. Beck" 4 => "D.W. Powell" 5 => "T.D. Cummins" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa0810457" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2009" "volumen" => "361" "paginaInicial" => "11" "paginaFinal" => "21" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19571279" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anti-phospholipase A2 receptor antibodies correlate with clinical status in idiopathic membranous nephropathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.M. Hofstra" 1 => "L.H. Beck Jr." 2 => "D.M. Beck" 3 => "J.F. Wetzels" 4 => "D.J. Salant" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2215/CJN.07210810" "Revista" => array:6 [ "tituloSerie" => "Clin J Am Soc Nephrol" "fecha" => "2011" "volumen" => "6" "paginaInicial" => "1286" "paginaFinal" => "1291" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21474589" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "PLA2R autoantibodies and PLA2R glomerular deposits in membranous nephropathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H. Debiec" 1 => "P. Ronco" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMc1011678" "Revista" => array:7 [ "tituloSerie" => "N Engl J Med" "fecha" => "2011" "volumen" => "364" "paginaInicial" => "689" "paginaFinal" => "690" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21323563" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1052305716302002" "estado" => "S300" "issn" => "10523057" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Membranous nephropathy: a journey from bench to bedside" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.M. Francis" 1 => "L.H. Beck Jr." 2 => "D.J. Salant:" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.ajkd.2016.01.030" "Revista" => array:7 [ "tituloSerie" => "Am J Kidney Dis" "fecha" => "2016" "volumen" => "68" "paginaInicial" => "138" "paginaFinal" => "147" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27085376" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S014067361600163X" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Enhanced expression of the M-type phospholipase A2 receptor in glomeruli correlates with serum receptor antibodies in primary membranous nephropathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Hoxha" 1 => "U. Kneissler" 2 => "G. Stege" 3 => "G. Zahner" 4 => "I. Thiele" 5 => "U. Panzer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/ki.2012.209" "Revista" => array:6 [ "tituloSerie" => "Kidney Int" "fecha" => "2012" "volumen" => "82" "paginaInicial" => "797" "paginaFinal" => "804" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22673885" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pathophysiological advances in membranous nephropathy: time for a shift in patient's care" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P. Ronco" 1 => "H. Debiec" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(15)60731-0" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2015" "volumen" => "385" "paginaInicial" => "1983" "paginaFinal" => "1992" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26090644" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anti-phospholipase A2 receptor antibody titer predicts post-rituximab outcome of membranous nephropathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Ruggenenti" 1 => "H. Debiec" 2 => "B. Ruggiero" 3 => "A. Chianca" 4 => "T. Pellé" 5 => "F. Gaspari" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1681/ASN.2014070640" "Revista" => array:6 [ "tituloSerie" => "J Am Soc Nephrol" "fecha" => "2015" "volumen" => "26" "paginaInicial" => "2545" "paginaFinal" => "2558" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25804280" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anti-PLA2R antibodies measured by ELISA predict long-term outcome in a prevalent population of patients with idiopathic membranous nephropathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Kanigicherla" 1 => "J. Gummadova" 2 => "E.A. McKenzie" 3 => "S.A. Roberts" 4 => "S. Harris" 5 => "M. Nikam" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Kidney Int" "fecha" => "2013" "volumen" => "83" "paginaInicial" => "940" "paginaFinal" => "948" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Differential diagnosis of membranous nephropathy with autoantibodies to phospholipase A2 receptor 1" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "W. Schlumberger" 1 => "N. Hornig" 2 => "S. Lange" 3 => "C. Probst" 4 => "L. Komorowski" 5 => "K. Fechner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.autrev.2013.09.005" "Revista" => array:6 [ "tituloSerie" => "Autoimmun Rev" "fecha" => "2014" "volumen" => "13" "paginaInicial" => "108" "paginaFinal" => "113" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24075959" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Phospholipase A2 receptor autoantibodies and clinical outcome in patients with primary membranous nephropathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "E. Hoxha" 1 => "I. Thiele" 2 => "G. Zahner" 3 => "U. Panzer" 4 => "S. Harendza" 5 => "R.A. 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