Child Kidney Dis.  2020 Apr;24(1):36-41. 10.3339/jkspn.2020.24.1.36.

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

• Choi SE
• Bae YS
• Lee KH
• Shin JI
• Jeong HJ
• Lim BJ

• KMID: 2500359
• DOI: http://doi.org/10.3339/jkspn.2020.24.1.36

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.

Keyword

Membranous glomerulonephritis; Phospholipase A2 receptor; Hepatitis B; Childhood