Background: Clinical practice guidelines recommend that a kidney biopsy is no longer required to confirm a diagnosis of membranous nephropathy (MN) in patients with nephrotic syndrome and a positive test for anti-phospholipase A2 receptor antibodies (PLA2R-Ab). However, the optimal diagnostic strategy for using the PLA2R-Ab enzyme-linked immunosorbent assay (ELISA), PLA2R-Ab indirect immunofluorescence (IIF) test, and genetic risk score for diagnosing MN, including the tests' optimal thresholds for positivity among incident patients with proteinuria, is still unknown.
Methods: We used serum samples at or before the first clinically indicated kidney biopsy from participants in the Nephrotic Syndrome Study Network (NEPTUNE) to analyze test performance characteristics using different combinations and cut-offs of the PLA2R-Ab ELISA, IIF, and genetic risk score for diagnosing MN. Secondary analyses included serum samples within 6 months after biopsy but before any immunosuppression use.
Results: There were 325 study participants with serum samples available on or before the day of kidney biopsy and an additional 143 study participants with samples within six months after biopsy but before any immunosuppression use. Of these participants, 26% (N=85) had biopsy-confirmed MN. The combination of ELISA ≥2 RU/mL and positive IIF was the optimal approach, with sensitivity of 0.60, specificity of 1.00, negative predictive value of 0.92, and positive predictive value of 1.00. Using IIF to confirm only borderline ELISA titers between 2-20 RU/ml resulted in similar sensitivity but specificity of >0.99. In our multiethnic study sample, we did not find improved diagnostic performance with the addition of genetic risk scores.
Conclusions: In the NEPTUNE cohort, combined PLA2R-Ab testing with ELISA and IIF provided optimal test characteristics in making a non-invasive diagnosis of MN before or soon after kidney biopsy, including in patients with sub-nephrotic proteinuria. Further studies in multiethnic populations are needed to assess whether genetic data can augment this approach.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.2215/CJN.0000000671 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Identification and mechanism analysis of biomarkers related to butyrate metabolism in COVID-19 patients.
Ann Med
December 2025
Department of Assisted Reproductive Centre, Xiangya Hospital Zhuzhou Central South University, Central South University, Zhuzhou, China.
Background: Butyrate may inhibit SARS-CoV-2 replication and affect the development of COVID-19. However, there have been no systematic comprehensive analyses of the role of butyrate metabolism-related genes (BMRGs) in COVID-19.
Methods: We performed differential expression analysis of BMRGs in the brain, liver and pancreas of COVID-19 patients and controls in GSE157852 and GSE151803.
Seabirds in crisis: Plastic ingestion induces proteomic signatures of multiorgan failure and neurodegeneration.
Sci Adv
March 2025
Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, 17 Liverpool Street, Hobart, Tasmania 7000, Australia.
Understanding plastics' harmful impacts on wildlife would benefit from the application of hypothesis agnostic testing commonly used in medical research to detect declines in population health. Adopting a data-driven, proteomic approach, we assessed changes in 745 proteins in a free-living nonmodel organism with differing levels of plastic exposure. Seabird chicks heavily affected by plastic ingestion demonstrated a range of negative health consequences: Intracellular components that should not be found in the blood were frequently detected, indicative of cell lysis.
View Article and Find Full Text PDFVancomycin- induced leukocytoclastic vasculitis in a patient with end-stage renal disease: a case report and literature review.
Daru
March 2025
Thoracic Research Center, Imam Khomeini, Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Introduction: Leukocytoclastic vasculitis (LCV) is a small-vessel inflammatory condition that can rarely occur as an adverse drug reaction (ADR). Vancomycin-induced LCV is an uncommon but potentially serious complication, particularly in patients with pre-existing renal impairment.
Reason For The Report: This case report describes a patient with end-stage renal disease (ESRD) who developed LCV following vancomycin therapy for a catheter-related infection.
Comparing oncologic outcomes of partial and radical nephrectomy for T2 renal cell carcinoma: a propensity score matching cohort study and an external multicenter validation.
World J Urol
March 2025
Department of Urology, Zhongda Hospital Southeast University, Nanjing, China.
Purpose: There is very limited evidence on the optimal surgical treatment for patients with larger T2 renal tumors. This study aims to evaluate the oncologic outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) in T2 renal cell carcinoma (RCC).
Methods: A retrospective data analysis was conducted on T2 RCC patients who underwent PN or RN between 2004 and 2019 using the SEER database, and validated with data from multiple centers in China from 2014 to 2019.
Pharmacokinetics of Ampicillin-Sulbactam in Azotemic and Non-Azotemic Dogs.
J Vet Pharmacol Ther
March 2025
Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Science, Colorado State University, Fort Collins, Colorado, USA.
Previous research has shown that azotemic dogs have a lower clearance and higher drug plasma concentrations of ampicillin compared to healthy dogs. The objective of this study was to determine the pharmacokinetics of ampicillin-sulbactam after multiple intravenous doses in hospitalized azotemic and non-azotemic dogs. This prospective study included 29 client-owned dogs; 19 azotemic and 10 non-azotemic.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!