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Primary membranous nephropathy in adolescence: A prospective study
Author(s) -
Kumar Vinod,
Varma Ashwani Kumar,
Nada Ritambhra,
Ghosh Ratan,
Suri Deepti,
Gupta Anju,
Kumar Vivek,
Rathi Manish,
Kohli Harbir,
Jha Vivekanand,
Gupta Krishan,
Ramachandran Raja
Publication year - 2017
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.12835
Subject(s) - medicine , membranous nephropathy , nephrotic syndrome , proteinuria , creatinine , renal biopsy , gastroenterology , population , prospective cohort study , biopsy , kidney , environmental health
Aim Primary membranous nephropathy (PMN) accounts for only 1–2% of nephrotic syndrome in children. Antibodies to m‐type phospholipase A2 receptor (aPLA 2 R) is seen in 70% of adult PMN cases. The present study was undertaken to study m‐type phospholipase A 2 receptor (PLA 2 R) status and clinical behavior in adolescent PMN cases. Methods The present prospective observational study included adolescent (10–19 years) onset biopsy proved PMN. Patients were followed on a monthly basis with urine protein, serum albumin and creatinine. Serum aPLA 2 R was done at baseline and at 6 and 12 months of starting treatment. Patients were treated as per unit's protocol. Results During the study period a total of 18 patients were enrolled. The mean age of the cases was 16.27 ± 2.39 (11–19) years. Seventeen (94.44%) patients presented with nephrotic syndrome. The mean proteinuria and serum albumin was 4.52 ± 1.93 (2.43–9.20) g/day and 2.1 ± 0.6 (1.1–3.4) g/dL respectively. PMN was PLA 2 R related in 83%. aPLA2R and enhanced staining for PLA 2 R in glomeruli was seen in 14 (77.78%) and 13 (72.22%), respectively. Clinical remission at the end of 6 and 12 months of therapy was seen in 11 (61.11%) and 9 (50%) subjects respectively. There was a significant association of aPLA 2 R to clinical remission/ resistance. Conclusion Primary membranous nephropathy in adolescent population is aPLA 2 R related in over three‐quarters of the cases and the response to therapy is seen in only half of them. aPLA 2 R monitoring is clinically relevant and should be incorporated in the management of adolescent onset PMN.