{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T17:52:37Z","timestamp":1779299557697,"version":"3.51.4"},"reference-count":16,"publisher":"S. Karger AG","issue":"2","license":[{"start":{"date-parts":[[2021,11,2]],"date-time":"2021-11-02T00:00:00Z","timestamp":1635811200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2021,11,2]],"date-time":"2021-11-02T00:00:00Z","timestamp":1635811200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Glomerular Dis"],"abstract":"<b><i>Introduction:<\/i><\/b> Anti-phospholipase A2 receptor (PLA2R) is detected in approximately 70% of biopsies of \u201cprimary\u201d membranous nephropathy (MN). Crescents in MN in nonlupus patients suggest additional injury, such as antineutrophil cytoplasmic antibody (ANCA) or anti-glomerular basement membrane (anti-GBM)-associated glomerulonephritis and are postulated to reflect injury by a mechanism that unmasks cryptic epitopes leading to the second autoantibody. <b><i>Methods:<\/i><\/b> We studied PLA2R staining in nonlupus patients with MN and crescents. Native renal biopsies in 16 nonlupus patients with MN and crescents were stained for PLA2R. <b><i>Results:<\/i><\/b> The patients included 5 women and 11 men, with mean age 61 years and elevated serum creatinine (mean 4.68 mg\/dL). Hematuria and proteinuria (mean 4.97 g\/day) were documented in 13 patients. Two patients had positive serum anti-GBM antibody. Nine of 11 patients tested for ANCA were positive, with p-ANCA (<i>n<\/i> = 4), c-ANCA (<i>n<\/i> = 2), or both (<i>n<\/i> = 1), with 2 not specified. On average, 27% of glomeruli had crescents. One patient had an initial biopsy with MN, 4 years later had MN with crescent, and 7 years later had rebiopsy with persistent MN with crescents. One patient had ANCA-associated vasculitis, and 5 years later had MN and crescent. The remaining 14 patients had concurrent diagnoses of MN and crescents. PLA2R was positive in 5 cases, 3 with ANCA positivity, 2 with unknown ANCA status, and none with anti-GBM disease. The patient with initial MN preceding crescent was PLA2R positive; the patient with initial ANCA-associated vasculitis preceding MN was PLA2R negative. <b><i>Conclusions:<\/i><\/b> Most patients (64%) presented with concomitant MN and crescents, with rare occurrence of an initial disease process followed later by the second injury. PLA2R was positive in 31% of patients, suggesting most are secondary MN. Further study to determine the cryptic epitopes may shed light on the triggering mechanisms for these rare but unlikely coincidental glomerular injuries. <\/jats:p>","DOI":"10.1159\/000520641","type":"journal-article","created":{"date-parts":[[2021,11,2]],"date-time":"2021-11-02T22:00:48Z","timestamp":1635890448000},"page":"75-82","source":"Crossref","is-referenced-by-count":4,"title":["Anti-Phospholipase A2 Receptor in Nonlupus Patients with Membranous Nephropathy and Crescents"],"prefix":"10.1159","volume":"2","author":[{"given":"Yiqin","family":"Zuo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3983-3184","authenticated-orcid":false,"given":"Livia Barreira","family":"Cavalcante","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5327-8976","authenticated-orcid":false,"given":"James Monroe","family":"Smelser","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neil","family":"Sanghani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jamie P.","family":"Dwyer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1530-7115","authenticated-orcid":false,"given":"Julia Breyer","family":"Lewis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Agnes B.","family":"Fogo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"127","published-online":{"date-parts":[[2021,11,2]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.11761116"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0810457"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2020.04.013"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2020.05.030"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1007\/s11255-015-1031-z"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1007\/s10157-017-1465-y"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2010090923"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1016\/j.ekir.2020.01.010"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.04060808"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1016\/j.ekir.2019.07.021"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2014.02.018"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197406132902403"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1620\/tjem.243.335"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1007\/s11255-013-0593-x"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfs145"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1093\/ajcp\/99.2.211"}],"container-title":["Glomerular Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.karger.com\/Article\/Pdf\/520641","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.karger.com\/Article\/Pdf\/520641","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T15:31:27Z","timestamp":1745422287000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000520641"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,2]]},"references-count":16,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,4,5]]},"published-print":{"date-parts":[[2022,4,7]]}},"URL":"https:\/\/doi.org\/10.1159\/000520641","archive":["Portico"],"relation":{},"ISSN":["2673-3633"],"issn-type":[{"value":"2673-3633","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,2]]}}}