Anti-PLA2R-associated membranous nephropathy: a review with emphasis on diagnostic testing methods

The majority of cases of primary membranous nephropathy (MN) are associated with auto-antibodies against the podocyte antigen M-type phospholipase A2 receptor (PLA2R). This particular subset of MN can be diagnosed by identifying anti-PLA2R within patient sera or by detecting PLA2R antigen within glomerular immune complexes in renal biopsy tissue. Since the discovery of anti-PLA2R in 2009, there has been an abundance of literature regarding PLA2R testing as a tool in the diagnosis and management of MN, and these tests are increasingly being implemented in clinical practice. However, questions still remain about a variety of issues such as PLA2R testing in the setting of presumably secondary MN and the significance of PLA2R negative primary MN. The goal of this review is to summarize the current PLA2R testing methods and highlight special features of anti- PLA2R-associated MN.