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HelpTest Code PMND1 Primary Membranous Nephropathy Diagnostic Cascade, Serum
Specimen Required
Supplies: Sarstedt Aliquot Tube, 5 mL (T914)
Collection Container/Tube:
Preferred: Serum gel
Acceptable: Red top
Submission Container/Tube: Plastic vial
Specimen Volume: 1 mL
Collection Instructions: Centrifuge and aliquot serum into a plastic vial.
Useful For
Distinguishing primary from secondary membranous nephropathy using an algorithmic approach
Monitoring patients with membranous nephropathy at very low antibody titers
Screening for anti-phospholipase A2 receptor antibodies
Profile Information
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| EURO | Phospholipase A2 Receptor, ELISA, S | Yes, (Order PLA2M) | Yes |
Reflex Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| PLA2I | PLA2R, Immunofluorescence, S | Yes | No |
| THSD7 | THSD7A Ab, S | Yes | No |
Testing Algorithm
The phospholipase A2 receptor (PLA2R) enzyme-linked immunosorbent assay (ELISA) is initially performed.
If the PLA2R ELISA result is less than 20, then the PLA2R immunofluorescence testing will be performed at an additional charge.
If the PLA2R immunofluorescence result is negative, thrombospondin type-1 domain-containing 7A (THSD7A) antibody testing will be performed at an additional charge.
Method Name
EURO: Enzyme-Linked Immunosorbent Assay (ELISA)
PLA2I, THSD7: Indirect Immunofluorescence Assay (IFA)
Reporting Name
Prim Membranous Nephropathy Diag, SSpecimen Type
SerumSpecimen Minimum Volume
1 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum | Refrigerated (preferred) | 14 days | |
| Frozen | 14 days | ||
| Ambient | 8 hours |
Reference Values
ANTI-PHOSPHOLIPASE A2 RECEPTOR (PLA2R) ENZYME-LINKED IMMUNOSORBENT ASSAY:
<14 RU/mL: Negative
14 to 19 RU/mL: Borderline
≥20 RU/mL: Positive
PLA2R IMMUNOFLUORESCENCE:
Negative
THROMBOSPONDIN TYPE-1 DOMAIN-CONTAINING 7A ANTIBODIES:
Negative
Interpretation
Therapy outcome can be monitored by measuring the anti-phospholipase A2 receptor (PLA2R) antibody titer. A titer increase, decrease, or disappearance generally precedes a change in clinical status. Thus, the determination of the antibody titer has a high predictive value with respect to clinical remission, relapse, or risk assessment after kidney transplantation.
According to the manufacturer's package insert, the EUROIMMUN Anti-PLA2R indirect immunofluorescence assay (IFA) was positive in 77.1% of patients with biopsy proven primary membranous nephropathy (pMN).(6) This corresponds well with published literature that approximately 70% of patients with pMN will have anti-PLA2R antibodies.
Clinical Reference
1. Beck Lh Jr, Bonegio RGB, Lambeau G, et al: M-type phospholipase A2 receptor as target antigen in idiopathic membranous nephropathy. N Engl J Med. 2009 Jul 2;361(1):11-21
2. Schlumberger W, Hornig N, Lange S, et al: Differential diagnosis of membranous nephropathy with autoantibodies to phospholipase A2 receptor 1. Autoimmun Rev. 2014 Feb;13(2)108-113
3. Tomas NM, Beck LH Jr, Meyer-Schwesinger C, et al: Thrombospondin type-1 domain-containing 7A in idiopathic membranous nephropathy. N Engl J Med. 2014 Dec 11;371(24):2277-2287. doi: 10.1056/NEJMoa1409354
4. Tomas NM, Hoxha E, Reinicke AT, et al: Autoantibodies against thrombospondin type 1 domain-containing 7A induce membranous nephropathy. J Clin Invest. 2016 Jul 1;126(7):2519-2532. doi: 10.1172/JCI85265
5. Stahl PR, Hoxha E, Wiech T, Schroder C, Simon R, Stahl RAK: THSD7A expression in human cancer. Genes Chromosomes Cancer. 2017 Apr;56(4):314-327. doi: 10.1002/gcc.22440
6. Package insert: EUROIMMUN Anti-PLA2R IFA Kit, EUROIMMUN US; V 09/24/2018
Day(s) Performed
Monday, Wednesday, Friday
Report Available
3 to 7 daysPerforming Laboratory
Mayo Clinic Laboratories in Rochester
Test Classification
See Individual Test IDsCPT Code Information
83520
86255 (x1 or x2, if applicable)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| PMND1 | Prim Membranous Nephropathy Diag, S | 73737-9 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| EURO | Phospholipase A2 Receptor, ELISA, S | 73737-9 |
Forms
If not ordering electronically, complete, print, and send a Renal Diagnostics Test Request (T830) with the specimen.