The value of renal biopsy in PLA2R- antibody-positive patients with proteinuria: impact of additional pathologies on management and prognosis in a Chinese Cohort

Introduction: R) antibodies (SAbs), a method to diagnose membranous nephropathy (MN) that replaces renal biopsy, is becoming increasingly accepted. However, whether SAb detection provides the same clinical value as renal biopsy is uncertain. Methods: R antibodies (SAb+). Results: Renal biopsy was performed in 414 SAb+ patients, 284 patients with primary membranous nephropathy (PMN) alone, 11 patients with atypical MN (AMN), 119 patients with PMN and diabetes mellitus (DM) or other pathologies, such as obesity-related glomerulopathy (ORG), renal tubular/interstitial injury (RTI), and ischemic kidney injury (IRI). There was no significant difference in the treatment or prognoses of MN patients with or without additional pathologies/DM. A high estimated glomerular filtration rate (eGFR) was associated with favorable prognosis (P<0.05), but additional pathologies were not significantly associated with it (P>0.05). Discussion: In conclusion, SAb+ can strongly predict MN (including in patients with DM) in China, but often coexists with additional pathologies. The presence of additional pathologies did not appear to be a significant determinant of management or prognosis. Renal biopsy is still necessary for accurate diagnosis, especially in patients with renal dysfunction.