Kidney Biopsy Is Required for Nephrotic Syndrome with PLA2R+ and Normal Kidney Function: The Con View

Kidney Biopsy Is Required for Nephrotic Syndrome with PLA2R+ and Normal Kidney Function: Commentary

“…However, this single study validates the need to study additional ancestral populations, beyond those included in the original Mayo Clinic study (8). The results described in the positive anti-PLA2R patients in the Bobart, et al study (8) presenting with Nephrotic Syndrome and potential secondary causes of MN, or Systemic diseases such as Diabetes, or an eGFR <60ml/min/1.73m2 demand that a kidney biopsy be undertaken as clearly stated in the CON position (7,8). And I agree.…”

“…All of the subjects were Chinese or Indian. No IFA results were reported so this study cannot be interpreted in relationship to the Bobart, et al criteria (7,8).…”

“…This phenomenon seems to be more common in patients with Diabetic Nephropathy, for unexplained reasons. The IFA is usually negative in such circumstances, and thus would not qualify as a positive test, according to the Bobart et al criteria (7,8). At the 2020 ERA-EDTA Virtual meeting an Abstract was presented by Mok and Choo (10) describing 31 patients with non-MN lesions on kidney biopsy who had positive ELISA anti-PLA2R tests-26 of whom had levels <50RU/ml and 5 of whom had levels >50RU/ml (ranging from 56 to 168RU/ml).…”

Syndrome néphrotique d’allure idiopathique après l’âge de 10 ans : intérêt de la biopsie rénale systématique au diagnostic

“…Chez l'adulte, la glomérulonéphrite extra-membraneuse primitive (GEM), principal diagnostic différentiel, a bénéficié ces dernières années d'avancées diagnostiques avec l'identification des anticorps anti-PLA2R détectés dans 70-80% des cas sur un simple bilan sanguin. [13][14][15] Ceci a conduit à remettre en question la stratégie diagnostique du SN de l'adulte et de ne discuter la réalisation de la PBR qu'en cas de sérologie PLA2R négative. 14,15 Les données de la cohorte francilienne NEPHROVIR-1 entre 2007 et 2010, ont montré que seulement 50% des enfants de plus de 10 ans avaient bénéficié d'une biopsie rénale.…”

Autoantibodies in the Diagnosis, Monitoring, and Treatment of Membranous Nephropathy

“…As anti-podocyte antibodies are highly specific for primary MN [well-documented for anti-PLA2R antibodies, where the specificity is 98–100% ( 54 )] it has been suggested that the diagnosis of primary MN may be assessed in patients with nephrotic syndrome, normal renal function and positive anti-PLA2R antibodies even without renal biopsy ( 54 ). However, there are several drawbacks.…”