Abstract
Background
Membranous glomerulopathy, though typically a disease of adults, does occur in children. Antiphospholipase A2 receptor (PLA2R) autoantibodies have recently been implicated as a causative agent in most cases of adult primary (idiopathic) membranous glomerulopathy. PLA2R staining of renal biopsies in two recent large case series of adults with primary membranous glomerulopathy showed a sensitivity of approximately 75 % for detecting primary membranous glomerulopathy. To our knowledge, this is the largest study of its kind to assess PLA2R staining in a pediatric population.
Methods
Forty-one consecutive cases of pediatric membranous glomerulopathy were identified from our database, and clinical follow-up was performed to confirm primary membranous glomerulopathy. Twenty-two patients met inclusion criteria and are the subject of this report.
Results
Granular, capillary loop immunofluorescence staining for immunoglobulin G (IgG) was present in 100 % of patients, and C3 staining was present in 77 %. PLA2R staining was identified in ten patients, providing a sensitivity of 45 % [confidence interval (CI) 25–67 %]. Bovine serum albumin staining was performed in all PLA2R-negative cases and showed no positivity. Morphologic findings associated with negative PLA2R staining included segmental membranous lesions, mesangial and subendothelial deposits, C1q and “full-house” staining, and lower-stage lesions by electron microscopy. At 38 months’ average follow-up, all patients were still considered as having primary membranous glomerulopathy, with none developing a clinically detectable secondary etiology.
Conclusions
PLA2R staining sensitivity is much lower in the pediatric than the adult primary membranous glomerulopathy population. This finding suggests a more diverse and currently incompletely described set of etiologies for this disease in this group.
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Acknowledgments
The authors thank Robert Yerton, Steve Strong, and Cindy Smith for their valuable technical aid and I-Shen Wen and Tina Priddy for their administrative support. The abstract to this work was presented at the USCAP 102nd Annual Meeting (2013), Baltimore, MD, USA (Mod Pathol 26: 383–396; doi:10.1038/modpathol.2013.16).
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Cossey, L.N., Walker, P.D. & Larsen, C.P. Phospholipase A2 receptor staining in pediatric idiopathic membranous glomerulopathy. Pediatr Nephrol 28, 2307–2311 (2013). https://doi.org/10.1007/s00467-013-2574-9
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DOI: https://doi.org/10.1007/s00467-013-2574-9