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KDIGO Connections: Membranous Glomerulopathy

Welcome to the first post in our new series KDIGO Connections, a series in which we are asking our nephrologist colleagues to educate us in real-world experiences treating kidney disease. In this series, Dr. David Bourne will be kicking it off with KDIGO guidelines for a kidney disease in visual abstract form. Our hope is that these posts will foster discussion regarding these diseases and how different providers approach them. Please share any points, pearls, questions, caveats, thoughts, or experience you have on the presented disease letting us all learn from your experience!  

PLA2R Tutorial

The diagnosis of membranous glomerulopathy has been transformed in the past 10 years with the discovery of PLA2R. PLA2R is the most common target antigen in cases of primary membranous glomerulopathy. Immunohistochemical staining for PLA2R (shown here) can detect the PLA2R type of membranous with high sensitivity and specificity. Recent studies have shown that serum testing for PLA2R antibodies can serve as a useful biomarker for monitoring the clinical activity of this disease. 

PLA2R

Autoantibody formation directed against PLA2R1 is the underlying etiology in most cases of primary membranous glomerulopathy. This new understanding of the pathogenesis of primary membranous has rapidly transformed diagnosis and monitoring of this disease. Proteinuria can take months to resolve after a patient has undergone serologic remission and, as a result, is not an ideal biomarker of disease activity. Testing for levels of serum PLA2R autoantibodies gives a more accurate picture of the patient’s current disease status. Ideally, serum PLA2R testing would be performed immediately after biopsy diagnosis in cases with positive PLA2R staining on biopsy. At this point in...