Abstract：
Membranous nephropathy (MN) is one of the most common causes of nephrotic syndrome (NS) in nondiabetic adults, with about 70%-80% of cases of MN being primary MN (pMN). Many studies have shown that serum phospholipase A2 receptor (PLA2R) antibodies are a diagnostic and prognostic biomarker for pMN, with a pooled diagnostic sensitivity and specificity of 54%-82% and 89%-100%, respectively, resulting in PLA2R staining and serum PLA2R antibodies being incorporated in the management algorithms of MN. We studied the sensitivity and specificity of serum PLA2R antibodies for diagnosing pMN and its correlation with PLA2R staining in kidney biopsies in a prospective observational study of 58 adult NS subjects undergoing a kidney biopsy. Serum PLA2R antibodies were determined by indirect immunofluorescence (IF) before the biopsy. Kidney biopsies were sent for light microscopy and IF examinations. Biopsy samples with MN histology were stained for PLA2R antigens. Out of the 58 adult NS subjects, 28 were diagnosed with pMN and one with secondary MN. Serum PLA2R antibodies were positive in 12 subjects with pMN, and one had focal segmental glomerulosclerosis not otherwise specified, giving a sensitivity of 42.8% and specificity of 96.7% for diagnosing pMN. There was a significant association between glomerular staining for PLA2R (24 of 28 subjects) and a diagnosis of pMN by kidney biopsy, with a sensitivity of 82.8%. Cohen\'s kappa agreement between glomerular staining for PLA2R and a diagnosis of MN was 0.83 (0.57-1.08).
摘要：
膜性肾病（MN）是非糖尿病成人肾病综合征（NS）的最常见原因之一。大约70%-80%的MN病例是原发性MN(pMN)。许多研究表明，血清磷脂酶A2受体（PLA2R）抗体是pMN的诊断和预后生物标志物，合并诊断灵敏度和特异性为54%-82%和89%-100%，分别,导致PLA2R染色和血清PLA2R抗体被纳入MN的管理算法。在一项对58例接受肾脏活检的成年NS受试者的前瞻性观察性研究中，我们研究了血清PLA2R抗体诊断pMN的敏感性和特异性及其与肾脏活检中PLA2R染色的相关性。活检前通过间接免疫荧光（IF）测定血清PLA2R抗体。送肾活检进行光学显微镜和IF检查。对具有MN组织学的活检样品进行PLA2R抗原染色。在58名成年NS受试者中，28例诊断为pMN，1例诊断为继发性MN。12例pMN患者血清PLA2R抗体阳性,其中一人患有局灶性节段性肾小球硬化，未另作说明，诊断pMN的敏感性为42.8%，特异性为96.7%。PLA2R的肾小球染色（28名受试者中有24名）与肾脏活检诊断pMN之间存在显着关联，灵敏度为82.8%。肾小球PLA2R染色与MN诊断之间的Cohenκ一致性为0.83（0.57-1.08）。
