Autoantibodies specific for the phospholipase A 2 receptor in recurrent and de novo membranous nephropathy

Abstract

Recent findings in idiopathic membranous nephropathy (MN) suggest that in most patients, the disease is because of anti-phospholipase A 2 receptor (PLA 2R1) autoantibodies. Our aim was to analyze the prevalence and significance of anti-PLA 2R1 antibodies in recurrent and de novo MN after transplantation. We assessed circulating PLA 2R1 autoantibodies by a direct immunofluorescence assay based on human embryonic kidney cells transfected with a PLA 2R1 cDNA, and the presence of PLA 2R1 antigen in immune deposits. We showed that PLA 2R1 was involved in 5 of 10 patients with recurrent MN, but in none of the 9 patients with de novo MN. We also showed a marked heterogeneity in the kinetics and titers of anti-PLA 2R1, which may relate to different pathogenic potential. We provide evidence that some patients with PLA 2R1-related idiopathic MN and anti-PLA 2R1 antibodies at the time of transplantation will not develop recurrence. Because PLA 2R1 autoantibody was not always associated with recurrence, its predictive value should be carefully analyzed in prospective studies. © 2011 The American Society of Transplantation and the American Society of Transplant Surgeons.