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Expression of Phospholipase A2 Receptor in Pediatric Hepatitis B Virus-Related Membranous Nephropathy

  • Choi, Sung-Eun (Department of Pathology, Yonsei University College of Medicine) ;
  • Bae, Yoon Sung (Department of Pathology, Yonsei University College of Medicine) ;
  • Lee, Keum Hwa (Department of Pediatrics, Yonsei University College of Medicine) ;
  • Shin, Jae Il (Department of Pediatrics, Yonsei University College of Medicine) ;
  • Jeong, Hyeon Joo (Department of Pathology, Yonsei University College of Medicine) ;
  • Lim, Beom Jin (Department of Pathology, Yonsei University College of Medicine)
  • Received : 2020.02.28
  • Accepted : 2020.04.09
  • Published : 2020.04.30

Abstract

Purpose: Hepatitis B virus (HBV) infection is among etiologies of secondary membranous nephropathy (MN) in pediatric patients. We evaluated expression of phospholipase A2 receptor (PLA2R), a specific target antigen of primary MN, in pediatric HBV-related MN. Methods: We retrospectively reviewed patients with biopsy-proven HBV-related MN from the renal biopsy registry and electronic medical records of Severance Hospital, Seoul, Korea, from 1993 to 2004. Paraffin-embedded human kidney tissues were retrieved and immunohistochemically stained for PLA2R. Results: Ten pediatric patients with 13 biopsied specimens were reviewed. The predominant pathological stage was stage II-III, and second was stage II. The intensity of staining for IgG was greatest, with less intense staining for IgM, IgA, C3, C4, and C1q. All the patients had angiotensin-converting enzyme inhibitor combined with glucocorticoid, and four patients converted to cyclosporine treatment from glucocorticoid monotherapy. Urinalysis of all the patients normalized after variable period. PLA2R staining was demonstrated in the outer glomerulus in 3 out of 13 biopsies, 2 of which were obtained from the same patient over a 5-year interval. Conclusions: PLA2R was expressed in a small number of cases diagnosed as pediatric HBV-related MN, indicating that some HBV-related MN cases may be primary MN concurrent with HBV infection.

Keywords

References

  1. Beck LH, Jr., Bonegio RG, Lambeau G, Beck DM, Powell DW, Cummins TD, et al. M-type phospholipase A2 receptor as target antigen in idiopathic membranous nephropathy. N Engl J Med 2009;361:11-21. https://doi.org/10.1056/NEJMoa0810457
  2. Chen A, Frank R, Vento S, Crosby V, Chandra M, Gauthier B, et al. Idiopathic membranous nephropathy in pediatric patients: presentation, response to therapy, and long-term outcome. BMC Nephrol 2007;8:11. https://doi.org/10.1186/1471-2369-8-11
  3. Glassock RJ. Secondary membranous glomerulonephritis. Nephrol Dial Transplant 1992;7 Suppl 1:64-71.
  4. Cattran DC. Membranous nephropathy: quo vadis? Kidney Int 2002;61:349-50. https://doi.org/10.1046/j.1523-1755.2002.00125.x
  5. Takekoshi Y, Tochimaru H, Nagata Y, Itami N. Immunopathogenetic mechanisms of hepatitis B virus-related glomerulopathy. Kidney Int Suppl 1991;35:S34-9.
  6. De Vriese AS, Glassock RJ, Nath KA, Sethi S, Fervenza FC. A Proposal for a Serology-Based Approach to Membranous Nephropathy. J Am Soc Nephrol 2017;28:421-30. https://doi.org/10.1681/ASN.2016070776
  7. Kupin WL. Viral-Associated GN: Hepatitis B and Other Viral Infections. Clin J Am Soc Nephrol 2017;12:1529-33. https://doi.org/10.2215/CJN.09180816
  8. Heymann W, Hackel DB, Harwood S, Wilson SG, Hunter JL. Production of nephrotic syndrome in rats by Freund's adjuvants and rat kidney suspensions. Proc Soc Exp Biol Med 1959;100:660-4. https://doi.org/10.3181/00379727-100-24736
  9. Kerjaschki D, Farquhar MG. The pathogenic antigen of Heymann nephritis is a membrane glycoprotein of the renal proximal tubule brush border. Proc Natl Acad Sci U S A 1982;79:5557-61. https://doi.org/10.1073/pnas.79.18.5557
  10. van de Logt AE, Fresquet M, Wetzels JF, Brenchley P. The anti-PLA2R antibody in membranous nephropathy: what we know and what remains a decade after its discovery. Kidney Int 2019;96:1292-302. https://doi.org/10.1016/j.kint.2019.07.014
  11. VanBeek C, Haas M. Anti-PLA2R-associated membranous nephropathy: a review with emphasis on diagnostic testing methods. Clin Nephrol 2015;84:1-9. https://doi.org/10.5414/CN108602
  12. Debiec H, Ronco P. PLA2R autoantibodies and PLA2R glomerular deposits in membranous nephropathy. N Engl J Med 2011;364:689-90. https://doi.org/10.1056/NEJMc1011678
  13. Kleinknecht C, Levy M, Gagnadoux MF, Habib R. Membranous glomerulonephritis with extra-renal disorders in children. Medicine (Baltimore) 1979;58:219-28. https://doi.org/10.1097/00005792-197905000-00002
  14. Johnson RJ, Couser WG. Hepatitis B infection and renal disease: clinical, immunopathogenetic and therapeutic considerations. Kidney Int 1990;37:663-76. https://doi.org/10.1038/ki.1990.32
  15. Bhimma R, Coovadia HM. Hepatitis B virus-associated nephropathy. Am J Nephrol 2004;24:198-211. https://doi.org/10.1159/000077065
  16. Gilbert RD, Wiggelinkhuizen J. The clinical course of hepatitis B virus-associated nephropathy. Pediatr Nephrol 1994;8:11-4. https://doi.org/10.1007/BF00868249
  17. Lai KN, Lai FM, Tam JS. Comparison of polyclonal and monoclonal antibodies in determination of glomerular deposits of hepatitis B virus antigens in hepatitis B virus-associated glomerulonephritides. Am J Clin Pathol 1989;92:159-65. https://doi.org/10.1093/ajcp/92.2.159
  18. Slusarczyk J, Michalak T, Nazarewicz-de Mezer T, Krawczynski K, Nowoslawski A. Membranous glomerulopathy associated with hepatitis B core antigen immune complexes in children. Am J Pathol 1980;98:29-43.
  19. Lai FM, To KF, Wang AY, Choi PC, Szeto CC, Li PK, et al. Hepatitis B virus-related nephropathy and lupus nephritis: morphologic similarities of two clinical entities. Mod Pathol 2000;13:166-72. https://doi.org/10.1038/modpathol.3880031
  20. Du Y, Li J, He F, Lv Y, Liu W, Wu P, et al. The diagnosis accuracy of PLA2R-AB in the diagnosis of idiopathic membranous nephropathy: a meta-analysis. PLoS One 2014;9:e104936. https://doi.org/10.1371/journal.pone.0104936
  21. Ren S, Wu C, Zhang Y, Wang AY, Li G, Wang L, et al. An update on clinical significance of use of THSD7A in diagnosing idiopathic membranous nephropathy: a systematic review and metaanalysis of THSD7A in IMN. Ren Fail 2018;40:306-13. https://doi.org/10.1080/0886022X.2018.1456457
  22. Kanda S, Horita S, Yanagihara T, Shimizu A, Hattori M. M-type phospholipase A2 receptor (PLA2R) glomerular staining in pediatric idiopathic membranous nephropathy. Pediatr Nephrol 2017;32:713-7. https://doi.org/10.1007/s00467-016-3552-9
  23. Svobodova B, Honsova E, Ronco P, Tesar V, Debiec H. Kidney biopsy is a sensitive tool for retrospective diagnosis of PLA2Rrelated membranous nephropathy. Nephrol Dial Transplant 2013;28:1839-44. https://doi.org/10.1093/ndt/gfs439
  24. Larsen CP, Messias NC, Silva FG, Messias E, Walker PD. Determination of primary versus secondary membranous glomerulopathy utilizing phospholipase A2 receptor staining in renal biopsies. Mod Pathol 2013;26:709-15. https://doi.org/10.1038/modpathol.2012.207
  25. Xie Q, Li Y, Xue J, Xiong Z, Wang L, Sun Z, et al. Renal phospholipase A2 receptor in hepatitis B virus-associated membranous nephropathy. Am J Nephrol 2015;41:345-53. https://doi.org/10.1159/000431331
  26. Hoxha E, Wiech T, Stahl PR, Zahner G, Tomas NM, Meyer-Schwesinger C, et al. A Mechanism for Cancer-Associated Membranous Nephropathy. N Engl J Med 2016;374:1995-6. https://doi.org/10.1056/NEJMc1511702
  27. Qin W, Beck LH, Jr., Zeng C, Chen Z, Li S, Zuo K, et al. Anti-phospholipase A2 receptor antibody in membranous nephropathy. J Am Soc Nephrol 2011;22:1137-43. https://doi.org/10.1681/ASN.2010090967
  28. Debiec H, Ronco P. Immunopathogenesis of membranous nephropathy: an update. Semin Immunopathol 2014;36:381-97. https://doi.org/10.1007/s00281-014-0423-y
  29. Sun IO, Hong YA, Park HS, Choi SR, Chung BH, Park CW, et al. Experience of anti-viral therapy in hepatitis B-associated membranous nephropathy, including Lamivudine-resistant strains. Korean J Intern Med 2012;27:411-6. https://doi.org/10.3904/kjim.2012.27.4.411