Distinguishing between primary and secondary subtypes of membranous glomerulonephritis (MGN) is critical for its clinical management. We prospectively compared direct immunofluorescence (DIF) staining for phospholipase A receptor (PLAR) on frozen renal biopsy with the presence of detectable serum PLAR antibody assessed by enzyme linked immunosorbent assay (ELISA) in the diagnosis of primary MGN. Forty-six patients with biopsy-proven MGN were enrolled from April 2017 to June 2019 with 31/46 (67.4%) being primary and 15/46 (32.6%) being secondary as determined by comprehensive clinical assessment. This is currently deemed to be the gold standard for distinguishing primary from secondary MGN. Amongst the 31 primary MGN patients, 24/31 were positive on PLAR DIF staining compared to 18/31 being positive on the PLAR ELISA (p=0.03). Amongst the 15 secondary MGN patients, 1/15 was positive on PLAR DIF compared to 0/15 on PLAR ELISA (p=1.0). In conclusion, the presence of PLAR staining on DIF demonstrated superior sensitivity and similar specificity compared to the detection of circulating PLAR antibodies by ELISA in the diagnosis of primary MGN in a cohort of 46 patients with biopsy-proven MGN. We suggest that DIF should be considered as part of routine work-up in all newly diagnosed cases of MGN.
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