Introduction The detection of serum anti-phospholipase A 2 receptor (PLA 2 R) antibodies (SAbs), a method to diagnose membranous nephropathy (MN) that replaces renal biopsy, is becoming increasingly accepted. However, whether SAb detection provides the same clinical value as renal biopsy is uncertain. Methods This study aimed to evaluate the value of renal biopsy in the diagnosis, treatment and prognosis of patients with proteinuria who are seropositive for PLA 2 R antibodies (SAb+). Results Renal biopsy was performed in 414 SAb+ patients, 284 patients with primary membranous nephropathy (PMN) alone, 11 patients with atypical MN (AMN), 119 patients with PMN and diabetes mellitus (DM) or other pathologies, such as obesity-related glomerulopathy (ORG), renal tubular/interstitial injury (RTI), and ischemic kidney injury (IRI). There was no significant difference in the treatment or prognoses of MN patients with or without additional pathologies/DM. A high estimated glomerular filtration rate (eGFR) was associated with favorable prognosis (P0.05), but additional pathologies were not significantly associated with it (P0.05). Discussion In conclusion, SAb+ can strongly predict MN (including in patients with DM) in China, but often coexists with additional pathologies. The presence of additional pathologies did not appear to be a significant determinant of management or prognosis. Renal biopsy is still necessary for accurate diagnosis, especially in patients with renal dysfunction.
Lu et al. (Sun,) studied this question.