Diagnostic value of phospholipase A₂ receptor in idiopathic membranous nephropathy: a systematic review and meta-analysis

Detection of M-type phospholipase A₂ receptor (PLA₂R) can be used in serologic diagnosis of idiopathic membranous nephropathy (IMN), but there are limited data about the sensitivity and specificity of its diagnostic values.

Meta-analysis of diagnostic test studies assessing the values of PLA₂R in diagnosis of IMN. MEDLINE, EMBASE, and CENTRAL databases and congress abstracts were searched for studies reporting the value of PLA₂R to predict IMN. The quality of the studies was evaluated using the guidelines of the updated Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. The results are summarized as sensitivity, specificity, and diagnostic odds ratio (OR). Data from 10 studies involving 1,550 participants were analyzed. Across all settings, the diagnostic OR for serum anti-PLA₂R level to predict IMN at different stages was 247.41, with sensitivity of 0.69 and specificity of 0.99. The estimated sensitivity and specificity of serum anti-PLA₂R level for diagnosis of IMN in the active stage were 74.0 and 95.0 %, respectively, with diagnostic OR of 54.22. The estimated sensitivity and specificity of biopsy anti-PLA₂R for diagnosis of IMN at different stages was 73.0 and 83.0 %, respectively, with diagnostic OR of 13.75.

This meta-analysis shows that serum anti-PLA₂R level is of diagnostic value for IMN in the active stage. Future large-cohort prospective studies are required to reveal the diagnostic value of circulating anti-PLA₂R antibodies versus PLA₂R antigens in kidney biopsy for IMN at different stages.