26576 Phospholipase A2 Receptor, Immunofluorescence, Serum (PLA2I)

Anti-PLA2R; PLA2R​

Distinguishing primary from secondary membranous nephropathy in patients with low levels of anti-phospholipase A2 receptor (PLA2R) antibodies

Screening for anti-PLA2R antibodies

Monitoring patients with membranous nephropathy at very low antibody titers

Gross hemolysis

​This test should not be used as a stand-alone test but an adjunct to other clinical information. A diagnosis of primary or secondary membranous nephropathy (MN) should not be made on a single test result. The clinical symptoms, results on physical examination, and laboratory tests (eg, serological tests), when appropriate, should always be taken into account when considering the diagnosis of primary versus secondary MN.

Absence of circulating anti-phospholipase A2 receptor autoantibodies does not rule out a diagnosis of primary MN.

​Membranous nephropathy (MN) is a rare disease in which immune complexes deposit at the glomerular basement membrane, causing damage to the filtration barrier, resulting in proteinuria. Recent studies have shown that in approximately 70% of patients with primary MN (pMN), the immune complexes consist of autoantibodies against the podocyte protein M-type phospholipase A2 receptor (PLA2R). There is also evidence that levels of anti-PLA2R autoantibodies correlate well with disease activity and progression. The presence of anti-PLA2R antibodies could also potentially be used to differentiate pMN from other causes of nephrotic syndrome if a biopsy is not possible. Among patients with chronic kidney disease (CKD) awaiting kidney transplantation, higher levels of anti-PLA2R could predict those more likely to recur after transplantation. Mayo Clinic Laboratory data suggest that there is a high concordance between the enzyme-linked immunosorbent assay and indirect immunofluorescence assay (IFA) PLA2R results, although the IFA may be more sensitive in monitoring patients with membranous nephropathy with very low antibody titers.

​According to the manufacturer's package insert, the EUROIMMUN Anti-PLA2R indirect immunofluorescence assay was positive in 77.1% of patients with biopsy proven primary membranous nephropathy (pMN). This corresponds well with published literature that approximately 70% of patients with pMN will have anti-phospholipase A2 receptor antibodies.