Anticuerpos anti-receptor de fosfolipasa A2 como biomarcador de nefropata membranosa

Diego Halab Robles Programa Doctorado en Ciencias Mdicas

Nefropata membranosa

Enfermedad glomerular mediada por

anticuerpos adultos

Mayor causa de sindrome nefrtico en Formacin complejos inmunes subepiteliales

+ activacin de complemento = proteinuria poco replicables

Heterogeneidad de NM y biomarcadores

Beck & Salant (2010)

M-type phospholipase A2 receptor (PLA2R)

C-R: cysteine-rich domain FNII: bronectin type II domain CTLD: C-type lectin-like domain

Rees & Kain (2009)

Anti-Phospholipase A2 Receptor Antibodies Correlate with Clinical Status in Idiopathic Membranous Nephropathy
Creatinina 2m Albumina IgG Transferrina -1-micro- globulina
Sndrome nefrtico Remisin espontnea Remisin inducida por tratamiento Proteinuria persistente Relapso Albmina srica <3.0 g/dl; proteinuria >3.5 g/d Reduccin de proteinuria >50% con proteinuria <3.5 g/d, sin tratamiento inmunosupresor Reduccin de proteinuria >50% con proteinuria <3.5 g/d despus de tratamiento inmunosupresor Proteinuria >3.5 g/d o reduccin de proteinuria <50% Proteinuria >3.5 g/d despus de una remisin

Creatinina srica Albumina Colesterol 2m IgG Transferrina

Hofstra et al. (2011)

Anti-Phospholipase A2 Receptor Antibodies Correlate with Clinical Status in Idiopathic Membranous Nephropathy

Hofstra et al. (2011)

Hofstra et al. (2011)

Hofstra et al. (2011)

Anti-Phospholipase A2 Receptor Antibody in Membranous Nephropathy

Qin et al., 2011

Anti-Phospholipase A2 Receptor Antibody in Membranous Nephropathy

Qin et al., 2011

Anti-Phospholipase A2 Receptor Antibody in Membranous Nephropathy

Qin et al., 2011

Anti-Phospholipase A2 Receptor Antibody in Membranous Nephropathy

Qin et al., 2011

Anti-Phospholipase A2 Receptor Antibody in Membranous Nephropathy

Qin et al., 2011

Anti-Phospholipase A2 Receptor Antibody in Membranous Nephropathy

Qin et al., 2011

Anti-Phospholipase A2 Receptor Antibody in Membranous Nephropathy

Qin et al., 2011

Anti-Phospholipase A2 Receptor Antibody in Membranous Nephropathy

Qin et al., 2011

Anti-Phospholipase A2 Receptor Antibody in Membranous Nephropathy

Qin et al., 2011

Lupus-MN

HBV-MN

Tumor-associated MN

Indirect immunouorescence test (IIFT)

Hoxha et al., 2011

An immunouorescence test for phospholipase-A2-receptor antibodies and its clinical usefulness in patients with membranous glomerulonephritis

Hoxha et al., 2011

Conclusiones

Anti-PLA2R parece ser un biomarcador able en NM No es un marcador del curso de la enfermedad, sino de la fase inmunolgica Es necesario implementar y validar test para diagnsticar NM basado en anticuerpos antiPLA2R Esto eviatara el diagnstico por biopsia, adems de permitir monitorear la enfermedad

Referencias

Beck, L.H. & Salant, D.J., 2010. Membranous nephropathy: recent travels and new roads ahead. Kidney international, 77(9), pp.76570. Debiec, H. & Ronco, P., 2011. Nephrotic syndrome: A new specic test for idiopathic membranous nephropathy. Nature reviews. Nephrology, 7(9), pp.4968. Hofstra, J.M. et al., 2011. Anti-phospholipase A receptor antibodies correlate with clinical status in idiopathic membranous nephropathy. Clinical journal of the American Society of Nephrology: CJASN, 6(6), pp.128691. Hoxha, E. et al., 2011. An immunouorescence test for phospholipase-A-receptor antibodies and its clinical usefulness in patients with membranous glomerulonephritis. Nephrology, dialysis, transplantation: ofcial publication of the European Dialysis and Transplant Association - European Renal Association, 26(8), pp.252632. Qin, W. et al., 2011. Anti-phospholipase A2 receptor antibody in membranous nephropathy. Journal of the American Society of Nephrology: JASN, 22(6), pp. 113743.