Distinguishing primary from secondary membranous nephropathy
Monitoring patients with membranous nephropathy, over time, for trends in anti-PLA2R antibody levels
Anti-phospholipase A2 Receptor (PLA2R) antibodies are highly specific for the diagnosis of primary membranous nephropathy.
As many as 70% to 75% of patients with primary membranous nephropathy are positive for anti-PLA2R.
A titer increase, decrease, or disappearance generally precedes a change in clinical status.
Test Id | Reporting Name | Available Separately | Always Performed |
---|---|---|---|
PA2RI | Phospholipase A2 Receptor IFA, S | Yes | No |
ELISA (PA2RE) testing is always performed initially. IFA testing (PA2RI) is performed based on the ELISA results. If ELISA results are greater than or equal 2 or less than or equal to 20 the IFA testing will reflex on.
Enzyme-Linked Immunosorbent Assay (ELISA)
Anti-PLA2R
PLA2R
ELISA (PA2RE) testing is always performed initially. IFA testing (PA2RI) is performed based on the ELISA results. If ELISA results are greater than or equal 2 or less than or equal to 20 the IFA testing will reflex on.
Serum
Collection Container/Tube:
Preferred: Serum gel
Acceptable: Red top
Specimen Volume: 1 mL
Collection Instructions:
1. Serum gel tubes should be centrifuged within 2 hours of collection.
2. Red-top tubes should be centrifuged and aliquoted within 2 hours of collection.
If not ordering electronically, complete, print, and send a Renal Diagnostics Test Request (T830) with the specimen.
0.5 mL
Gross hemolysis | Reject |
Gross lipemia | OK |
Specimen Type | Temperature | Time | Special Container |
---|---|---|---|
Serum | Refrigerated (preferred) | 14 days | |
Frozen | 14 days | ||
Ambient | 8 hours |
Distinguishing primary from secondary membranous nephropathy
Monitoring patients with membranous nephropathy, over time, for trends in anti-PLA2R antibody levels
ELISA (PA2RE) testing is always performed initially. IFA testing (PA2RI) is performed based on the ELISA results. If ELISA results are greater than or equal 2 or less than or equal to 20 the IFA testing will reflex on.
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).(1) There is also evidence that levels of anti-PLA2R autoantibodies correlate well with disease activity and progression.(2) 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.(2) Mayo Clinic Renal Lab data suggest that there is a high-concordance between the enzyme-linked immunosorbent assay (ELISA) and indirect immunofluorescence assay PLA2R results; however, the ELISA assay alone may be preferred for monitoring patients with membranous nephropathy over time for trends in anti-PLA2R antibody levels.
Negative: <14 RU/mL
Borderline: > or =14-19 RU/mL
Positive: > 19 RU/mL
Therapy outcome can be monitored by measuring the anti-phospholipase A2 receptor (PLA2R) antibody titer. A titer increase, decrease, or disappearance generally precedes a change in clinical status. Thus, the determination of the antibody titer has a high predictive value with respect to clinical remission, relapse, or risk assessment after kidney transplantation.
Absence of circulating anti-phospholipase A2 receptor (PLA2R) autoantibodies does not rule out a diagnosis of primary MN.
2. Schlumberger W, Hornig N, Lange S, et al: Differential diagnosis of membranous nephropathy with autoantibodies to phospholipase A2 receptor 1. Autoimmun Rev 2014 Feb;13(2)108-113
The test kit provides microtiter strips each with 8 break-off reagent wells. In the case of positive samples, specific IgG antibodies (also IgA and IgM) will bind to the antigens. To detect the bound antibodies, a second incubation is carried out using an enzyme-labelled antihuman IgG (enzyme conjugate) catalyzing a color reaction.(Package insert: EUROIMMUN Anti-PLA2R ELISA [IgG] Kit, EUROIMMUN US, Morris Plains, NJ, V 9/23/2014)
Monday through Friday
This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.
83520
Test Id | Test Order Name | Order LOINC Value |
---|---|---|
PA2RE | Phospholipase A2 Receptor ELISA, S | 73737-9 |
Result Id | Test Result Name |
Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
|
---|---|---|
PA2RE | Phospholipase A2 Receptor ELISA, S | 73737-9 |