Serum anti-PLA2R negativity does not exclude glomerular PLA2R expression in primary membranous nephropathy
Biomolecules and Biomedicine, cilt.26, sa.10, ss.1881-1890, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 26 Sayı: 10
- Basım Tarihi: 2026
- Doi Numarası: 10.17305/bb.2026.14167
- Dergi Adı: Biomolecules and Biomedicine
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, EMBASE, MEDLINE, Directory of Open Access Journals, Biomedical Reference Collection: Corporate Edition (EBSCO)
- Sayfa Sayıları: ss.1881-1890
- Anahtar Kelimeler: anti-PLA2R antibodies, glomerular PLA2R expression, kidney-as-a-sink hypothesis, Primary membranous nephropathy, renal biopsy
- Açık Arşiv Koleksiyonu: AVESİS Açık Erişim Koleksiyonu
- Akdeniz Üniversitesi Adresli: Evet
Özet
Primary membranous nephropathy (pMN) is a principal cause of nephrotic syndrome in adults. The identification of the M-type phospholipase A2 receptor (PLA2R) antigen has significantly advanced non-invasive management; however, the precise clinical relationship between circulating antibody titers and intrarenal antigen deposition continues to be debated. This single-center retrospective study sought to analyze the correlation between clinicopathological parameters, serum anti-PLA2R levels, and glomerular PLA2R tissue expression in pMN. A specific focus was placed on evaluating the diagnostic utility of tissue staining in seronegative patients. A cohort of 49 adult pMN patients, diagnosed via renal biopsy between 2018 and 2025, was evaluated. Serum anti-PLA2R antibodies were quantified using ELISA, while glomerular PLA2R expression and staining intensity (graded 0 to +3) were assessed via immunohistochemistry (IHC) on paraffin-embedded sections. The results demonstrated a notable discordance: the overaserum antibody positivity rate was 49.0%, yet tissue PLA2R expression was detected in 100% of the cohort, encompassing all seronegative cases. A statistically significant difference was observed in the distribution of tissue PLA2R staining intensity based on serum PLA2R status (P = 0.002). Conversely, no statistically significant correlation was found between circulating antibody titers anbaseline renal function or proteinuria markers (P > 0.05). In conclusion, these findings indicate that negative serology does not preclude tissue PLA2R positivity, potentially attributable to mechanisms such as the “kidney-as-a-sink” phenomenon or persistent immunological footprints. This investigation underscores that serum and tissue PLA2R serve as complementary, rather than mutually exclusive, markers. Consequently, renal biopsy with supplementary IHC staining remains a crucial and clinically valuable diagnostic tool, particularly in seronegative cases.