Profile of Primary Membranous Nephropathy among Membranous Nephropathy Patients Based on PLA2 Receptor Staining in Biopsy

Mohamed Aaseem Arshad, V S (2021) Profile of Primary Membranous Nephropathy among Membranous Nephropathy Patients Based on PLA2 Receptor Staining in Biopsy. Masters thesis, Tirunelveli Medical College, Tirunelveli.


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INTRODUCTION: Membranous nephropathy is one of the common cause of nephrotic syndrome in adults. MN usually presents with nephrotic syndrome or heavy proteinuria, while renal function is often normal or near normal. Disease progression is variable, with one-third remitting spontaneously, one-third progressing to ESRD, and one-third with an intermediate course. The discrimination between primary and secondary membranous nephropathy is essential because of treatment implications. The treatment for primary MN is steroid and steroid sparing immunosuppressive drugs while secondary MN we have to treat the underlying cause also. Immunohistochemistry evaluation with the help of PLA2 receptor antibody helps in tissue evaluation of primary membranous nephropathy, which is an easy cost effective, pathologist friendly technique. OBJECTIVES: 1. To find the proportion of membranous nephropathy among adult nephrotic syndrome cases admitted in TVMCH. 2. Sensitivity and specificity of the PLA2R antigen in identifying the idiopathic membranous nephropathy cases. 3. Clinical, biochemical & histopathological profile of idiopathic membranous nephropathy (IMN). 4. To study the response of IMN patients to treatment with modified Ponticelli regimen over a period of 6 months. MATERIALS AND METHODS: Patients who are admitted in the nephrology ward of TMVCH satisfying nephrotic syndrome criteria between the period of 2018-2020. Patients less than 18 years and pregnant females were excluded and renal insufficiency in the form of urea more than 40 mg/dl and creatinine more than 1.2 mg/dl was also included as a criteria. All the 80 patients taken in the study were subjected to renal biopsy and PLA2R immunofluorescence staining was done in membranous nephropathy biopsy specimens. Those patients who were positive for PLA2R were diagnosed as IMN and modified Ponticelli regimen was started and continued for six months. Patients were followed up for resolution of renal failure and proteinuria. RESULTS AND OBSERVATION: Out of 80 nephrotic syndrome patients in our study , 23 were membranous nephropathy. PLA2R staining positivity was present in 18 cases making them idiopathic membranous nephropathy. Out of remaining 5, 2 patients had lupus nephritis and 1 patients had malignancy, 1 patients had hepatitis B and 1 patient had hepatitis C. IMN patients started on modified Ponticelli regimen, 69.6% had complete recovery,8.7% had partial remission, 3 patients developed ESRD (13%) and 2 patients died during follow up period (8.7%). The sensitivity of PLA2R is 86.9% and specificity is 100% in identifying primary membranous nephropathy. CONCLUSION: From our study, the most common cause of nephrotic syndrome in adults is membranous nephropathy (35% among adult nephrotic syndrome patients). Males are twice affected than females (2:1) • Primary membranous nephropathy is more common than secondary membranous nephropathy. 82% of the membranous nephropathy cases were primary. • Due to its 100% specificity ruling out the innumerable secondary causes of MNis not routinely required if PLA2R is positive in biopsy. • The modified Ponticelli regimen has a complete remission rate of 69.6% which is non-inferior to newer regimens containing Mycofenolate Mofetil (remission rate-70%) and calcineurin inhibitors (50% at 6 months and 80% in one year).

Item Type: Thesis (Masters)
Additional Information: 201811364
Uncontrolled Keywords: Idiopathic Membranous Nephropathy (IMN), Phospholipase A2 Receptor (PLA2R), End Stage Renal Disease 9ESRD), Membranous Nephropathy (MN).
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 24 Apr 2021 10:06
Last Modified: 09 Jan 2022 13:37

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