The association of anti-PLA2R with clinical manifestations and outcomes in idiopathic membranous nephropathy: a meta-analysis

The meta-analysis aims to investigate the relationship between anti-phospholipase A2 receptor autoantibody (anti-PLA2R) and clinical characteristics and adverse outcomes of idiopathic membranous nephropathy (IMN). Related studies published before February 2020 were systematically retrieved from foreign and domestic databases, RevMan5.3 software was used for meta-analysis and subgroup analysis, and STATA 15.0 statistical software was used for its heterogeneity and testing publication bias. Twenty studies were included, involving 2224 patients with IMN. Our results showed that a significant correlation existed between the expression of serum anti-PLA2R and age (MD = 2.91, 95% CI = 2.15–3.67, P < 0.00001), total serum cholesterol (MD = 35.52, 95% CI = 9.52–61.52, P = 0.007), urine protein by creatinine ratio (UPCR) (MD = 2.15, 95% CI = 1.86–2.44, P<0.00001), serum albumin (MD = −0.40, 95% CI = −0.56 to −0.23, P < 0.00001), eGFR (MD = −10.44, 95% CI = −12.19 to −8.68, P < 0.00001), unremission rate (RR = 1.76, 95% CI = 1.37–2.27, P < 0.0001). In addition, the high titer in seropositive group was closely correlated with serum albumin (MD = −0.40, 95% CI = −0.74 to −0.05, P = 0.03), eGFR (MD = −12.40, 95% CI = −16.29 to −8.52, P < 0.00001) and unremission rate (RR = 2.52, 95% CI = 1.79–3.55, P < 0.00001). No significant correlation was found between glomerular anti-PLA2R and clinical manifestations except for serum cholesterol (MD = 0.81, 95% CI = 0.21–1.41, P = 0.008). However, in terms of prognosis, glomerular anti-PLA2R showed a significant relevance to recurrence rate (RR = 2.25, 95% CI = 1.07–4.72, P = 0.03). Compared with glomerular anti-PLA2R, serum anti-PLA2R may better reflect the activities of IMN disease, while the glomerular anti-PLA2R might be connected with the recurrence of the disease.