ABSTRACT
Membranous nephropathy (MN) is one of the most frequent causes of nephrotic syndrome. Renal biopsy is nowadays the gold standard for the diagnosis of MN. The presence of circulating PLA2R antibody is a very specific tool for the diagnosis of this disease, especially associated with primary or idiopathic MN (IMN), even though it can be also found in a small proportion of patients with secondary MN (SMN). This pilot study compares three different techniques for the detection of anti-PLA2R autoantibodies (immunofluorescence, ELISA immunoassay, and multiplex laser bead technology). Serum of 12 IMN and 9 SMN patients was obtained at diagnosis. Additionally, we employed serum samples of 15 healthy volunteers. From our patient cohort, we obtained a 7.75 RU/ml cut-off for the ELISA and 3104 MFI for the Luminex assays. The agreement between the three techniques improved considerably when applying the new cut-off points. As several authors have suggested, cut-offs may be calculated for each specific population instead of establishing global cut-off points. Patients with IMN showed significantly lower serum albumin levels and higher 24 h proteinuria compared to those with SMN. Analysis of ROC curves suggests that ELISA and LUMINEX assays are more useful than biochemical variables to differentiate patients with IMN and SMN. This pilot study contributes to confirming that the combination of ELISA and Luminex assays provide excellent sensitivity and specificity for the identification of IMN.
Subject(s)
Autoantibodies/immunology , Enzyme-Linked Immunosorbent Assay/methods , Fluorescent Antibody Technique, Indirect/methods , Glomerulonephritis, Membranous/diagnosis , Receptors, Phospholipase A2/immunology , Aged , Case-Control Studies , Female , Glomerulonephritis, Membranous/immunology , Glomerulonephritis, Membranous/metabolism , Humans , Immunoassay/methods , Male , Pilot Projects , Proteinuria/urine , Sensitivity and Specificity , Serum Albumin/metabolism , Thrombospondins/immunology , White PeopleABSTRACT
With aging population and chronic kidney disease burden increasing worldwide, the need for renal replacement therapy is rising and our patients are getting more complex due to comorbidities and long-standing kidney disease. Deteriorated vascular capital is a frequent feature we have to deal with these days, making even obtaining routine blood tests a hard task. We present two case reports of peritoneal dialysis patients without a peripheral vein access were a Port-a-Cath (Port-a-Cath® Deltec® Smiths Medical) was placed to sort out long-term access. Port-a-Cath manipulation was simple, safe and had no complications neither at implantation nor during its use. We believe that Port-a-Cath placement is an option to be considered when coping with end-stage venous access.
Subject(s)
Catheterization, Central Venous/instrumentation , Jugular Veins , Peritoneal Dialysis/instrumentation , Renal Insufficiency, Chronic/therapy , Subclavian Vein , Vascular Access Devices , Female , Humans , Jugular Veins/diagnostic imaging , Male , Middle Aged , Punctures , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/physiopathology , Subclavian Vein/diagnostic imaging , Treatment OutcomeABSTRACT
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