PLA2R Membranous Nephropathy Treatment By American Hospital Dubai

Case 1 of: PLA2R Membranous Nephropathy Treatment By American Hospital Dubai

Case history: How did the journey begin? 

TD, a 60-year-old female, developed swelling or edema caused by fluid retention (most commonly in the legs and feet), had high blood pressure and was outputting protein in the urine. In 2020, she had a kidney biopsy which revealed a common autoimmune condition called Membranous Nephropathy (MN). This condition is caused due to the thickening of kidneys’ filtering membranes that help sieve waste and extra fluid from the blood. The swelling or thickening of these membranes impairs their functioning. 

Initial Assessment and Accurate Diagnosis 

When a patient presents with protein in urine and swelling in the body’s extremities, tests to check for Membranous Nephropathy usually involve a kidney biopsy. Our Nephrology Department correctly diagnosed TD’s condition as MN.  

Achieving the Treatment Breakthrough 

TD was placed on autoimmune treatment, which controlled her proteinuria (presence of protein in the urine) but caused several side effects, including reduced kidney function. Our nephrology team stepped in and conducted further investigations, which showed she was in remission, as revealed by her blood serum markers of PLA2R.  

What is PLA2R? 

Each kidney filtering unit, called glomerulus, comprises three layers: endothelial cells, podocytes (type of cells), and the Glomerular basement membrane (GBM). The podocytes have a protein called phospholipase A2 receptor (PLA2R). In MN, the immune system’s antibodies attack the podocytes, damaging them, and as a result, these cells, instead of holding on to their protein PLA2R, let it leak into the bloodstream, ending up in the urine. This is why TD’s urine was outputting protein. 

As TD’s PLA2R markers improved, we decided to wean her off the immunosuppressive therapy to avoid further side effects. Our progressive and patient-centric care philosophy drove this decision and is the foundation of American Hospital Dubai’s excellence in medical care.  

It was a critical juncture incident as it changed the course of TD’s treatment for the better and points to the timely interventionist expertise of our nephrology team.

How We Ensure a Positive Care Outcome 

TD was slowly tapered off the medications, and they were completely stopped in 2021. Her kidney function and protein levels in her blood stabilized, and overall, she felt much better.  

She is still under surveillance, and we ensure her disease stays in remission. 

Even though the immunosuppression treatment was necessary, she suffered due to its side effects, and our calculated decision to take her off medications safely boosted her overall health. We achieved this positive outcome by bringing a penetrative and encompassing clinical evaluation based on the PLA2R marker. Incorporating this new marker into clinical decision-making is the trend in treating Membranous Nephropathy, and we are proud to say we ensured it was done most productively.

Conclusion 

Membranous Nephropathy (MN) is still evolving to present newer solutions for treatment and management, and it is essential to keep abreast of them. American Hospital Dubai’s nephrology team ensures the highest degree of diagnostic accuracy, informed decision-making, and clinical evaluation to determine the best treatment pathways to ensure the patient’s health and progression. 

Case 2 of: PLA2R Membranous Nephropathy Treatment By American Hospital Dubai

AE, a 62-year-old male, was suffering from fluid retention, leading to swelling and protein in his urine. He had no kidney issues before this condition and was referred to our Nephrology Department for further evaluation.  

Initial Assessment and Accurate Diagnosis 

When a patient presents with protein in urine and swelling in the body, tests to check for Membranous Nephropathy (MN) usually involve a kidney biopsy. However, AE was deeply anxious about undergoing a biopsy. 

Our nephrology team first decided to conduct several blood tests on AE, which showed elevated PLA2R antibody levels and normal creatinine levels. The test results were specific enough to diagnose him with Membranous Nephropathy without requiring a kidney biopsy. The conclusion reiterated our Nephrology team’s high-level expertise and evaluator skills that accurately and speedily identified the patient’s condition using the most appropriate approach. It saved the patient from further anxiety about a kidney biopsy. 

What is PLA2R? 

Each kidney filtering unit, called glomerulus, comprises three layers: endothelial cells, podocytes (type of cells), and the Glomerular basement membrane (GBM). The podocytes have a protein called phospholipase A2 receptor (PLA2R). In MN, the immune system’s antibodies attack the podocytes, damaging them, and as a result, these cells, instead of holding on to their protein PLA2R, let it leak into the bloodstream, ending up in the urine.  
It is the reason AE’s urine was outputting protein. 

Achieving the Treatment Breakthrough 

AE was started on blood pressure and cholesterol medications because one of the consequences of Membranous Nephropathy (MN) is high blood pressure and elevated cholesterol levels due to protein loss through the urine. 

We monitored his blood levels of PLA2R to assess the disease pathway; as a result, his proteinuria (presence of protein in the urine) improved, and he did not require immunosuppressive therapy. High levels of PLA2R can lead to the patient being put on immunosuppressant or autoimmune treatment because MN is caused by an autoimmune disorder that causes the thickening of the kidneys’ filtering membranes and their impaired function, if not addressed in time, can lead to kidney failure.