Detection of anti-PLA2R autoantibodies and IgG subclasses in post-allogeneic hematopoietic stem cell transplantation membranous nephropathy

Am J Med Sci. 2013 Jul;346(1):32-7. doi: 10.1097/MAJ.0b013e318267b5cd.


Background: Membranous nephropathy (MN) is the most common glomerular disease of post-allogeneic hematopoietic stem cell transplantation (HSCT). Although this condition is now considered a renal complication of chronic graft-versus-host disease (cGVHD), the pathogenesis of this disease is not well established.

Methods: Five patients with post-HSCT MN diagnosed by renal biopsy were selected for this study. The clinical and renal pathological data of these patients were analyzed, and anti-PLA2R (M-type phospholipase A2 receptor) autoantibodies and IgG subclasses were detected in the serum samples from the patients.

Results: None of the 5 patients had a history of kidney disease. All the patients had a combination of cGVHD and proteinuria, which was in remission after an effective anti-graft-versus-host disease treatment. The immunofluorescent detection showed that IgG4 was the predominant IgG subclass, and the distribution of IgG4 was the same as that of nephrin. The anti-PLA2R autoantibodies were negative in 4 patients and positive in 1 patient. The levels of IgG2, IgG3 and IgG4 increased in the majority of the patients.

Conclusions: Our data showed that the clinical course of post-HSCT MN patients was closely related to that of cGVHD. Although the renal pathology was similar to idiopathic MN, the negative result for the anti-PLA2R autoantibodies in the majority of the patients suggested that the formation of an immune complex occurs differently between these 2 diseases.

MeSH terms

  • Adult
  • Autoantibodies / blood*
  • Blotting, Western
  • Female
  • Glomerulonephritis, Membranous / blood
  • Glomerulonephritis, Membranous / immunology*
  • HEK293 Cells
  • Hematopoietic Stem Cell Transplantation / adverse effects*
  • Humans
  • Immunoglobulin G / blood*
  • Male
  • Microscopy, Fluorescence
  • Middle Aged
  • Receptors, Phospholipase A2 / immunology*


  • Autoantibodies
  • Immunoglobulin G
  • Receptors, Phospholipase A2