Correlation between Pathological Staging of Membranous Nephropathy and PLA2R Antigen Expression and Its Predictive Value for Treatment Response

Objective: To investigate the clinical practice patterns of membranous nephropathy (MN) patients in our center, analyze the distribution of pathological stages and their associations with chronic pathological changes, immunofluorescence characteristics, and comorbidities, and provide a descriptive analysis of PLA2R detection in the very few cases where it was performed. Methods: Clinical data, pathological findings, and PLA2R detection results of 30 MN patients were retrospectively collected. The associations between pathological stages and chronic lesions or immunofluorescence features were analyzed, and the current status of PLA2R detection was described. Results: Among the 30 patients, pathological stages were: stage I, 1 case; stage II, 16 cases; stage III, 9 cases; and class V (lupus), 1 case; secondary MN accounted for 3 cases. The PLA2R detection rate was very low (6.7%, 2/30). Both positive cases were patients with stage III primary MN (positivity rate 22.2%, 2/9), while no positive expression was detected in stage I, II, or secondary MN patients. The later the pathological stage, the higher the incidence of glomerulosclerosis (stage III 77.8% vs stage II 31.3% vs stage I 0%) and moderate-to-severe tubulointerstitial injury (stage III 55.6% vs stage II 18.8% vs stage I 0%), with statistically significant differences (P < 0.05). Immunofluorescence in primary MN was predominantly characterized by IgG and C3 deposition, whereas secondary MN showed a “full-house” or multiple immune complex deposition pattern. Common comorbidities included hepatitis B virus infection/carrier status (4 cases), systemic lupus erythematosus (1 case), and hypertension (4 cases). Conclusion: In this cohort, PLA2R testing was not routinely performed. Its positivity in stage III primary MN is noteworthy, but due to the extremely low detection rate, its precise correlation with pathological stages and its predictive value for treatment response require confirmation through large-scale prospective studies. Pathological stage III can serve as a significant marker for chronic progression in MN. Immunofluorescence characteristics are valuable for differentiating primary from secondary MN, and comorbidity screening is crucial for clinical management. The findings suggest that future research should standardize PLA2R testing and systematically collect follow-up data to further explore its clinical significance.