ANTI-PLA2R ANTIBODY AND PRIMARY MEMBRANOUS NEPHROPATHY: A LITERATURE REVIEW (Atena Editora)

Abstract

Membranous nephropathy is the most common cause of nephrotic syndrome in non-diabetic Caucasian adults over 40 years of age and a leading cause of nephrotic syndrome in adults. Classified into primary and secondary membranous nephropathy related to various conditions including infection (hepatitis B), systemic disease (SLE and sarcoidosis), medications (nonsteroidal anti-inflammatory drugs), thyroiditis, and malignancy. Evidence of the clinical utility of measuring PLA2R plasma levels has increased over the last 2 years and was the main focus of this review. The guiding question was: “What is the clinical applicability of the anti-PLA2R antibody in the management of primary membranous nephropathy, as reported in the literature?”. The literature review was developed following the PICO search strategy. All patients with primary membranous nephropathy must be treated with supportive care from the time of diagnosis to minimize protein excretion. Patients with elevated anti-PLA2R levels and proteinuria >3.5 g/d at diagnosis and those who fail to reduce proteinuria to <3.5 g after 6 months of supportive care or have complications of nephrotic syndrome must be considered for immunosuppressive therapy. Accepted regimens include steroids/cyclophosphamide, calcineurin inhibitors, and B-cell depletion. The anti-PLA2R antibody is the first serological marker that has promising evidence to be used as a tool to predict the course of the disease. More importantly, therapeutic agents such as rituximab and adrenocorticotropic hormone analogues are new therapeutic options that must be considered in the therapy of primary MN.