Abstract
Background
International practice guidelines advocate for the use of anti-phospholipase A2 receptor (PLA2R) antibody testing to diagnose primary membranous nephropathy (pMN). This study aimed to clarify the current status of anti-PLA2R antibody testing in the diagnosis of pMN in Japan and to scrutinize the factors associated with the implementation of this antibody test.
Methods
Utilizing a web-based questionnaire for nephrologists, responses were collected from 306 facilities and 427 nephrologists between November 2021 and December 2021. Preference for anti-PLA2R antibody testing was also investigated. Factors related to the experience of quantifying anti-PLA2R antibodies were estimated by generalized estimating equations using a robust analysis of variance with clusters of facilities of affiliation.
Results
Of the 427 respondents, 140 (32.8%) had previous measurement experience at their current workplace and 165 (38.6%) had previous measurement experience overall. In pMN-suspected cases without contraindications to renal biopsy, 147 (34.4%) of the respondents opted to request anti-PLA2R antibody testing. The respondents’ experience with anti-PLA2R antibody quantification at their current place of work was generally higher in university hospitals and increased with the annual number of kidney biopsies and the number of years since graduation.
Conclusion
The results of this study suggest that a significant proportion of nephrologists in Japan have no experience in performing anti-PLA2R antibody assays, and that the assays may be hampered by the limited capabilities of the current workplace and the financial burden on facilities and patients.
Similar content being viewed by others
Data availability
The data underlying this article will be shared upon reasonable request from the corresponding authors.
References
Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group. KDIGO. Clinical Practice Guideline for the Management of Glomerular Diseases. Kidney Int. 2021;2021(100):S1–276. https://doi.org/10.1016/j.kint.2021.05.021.
Narita I, Okada H, Yasuda Y, Shibagaki Y, Wada T, Akiyama S, et al. (2020). Evidence-based clinical practice guidelines for nephrotic syndrome 2020. Tokyo Igakusha.
Wada T, Ishimoto T, Nakaya I, Kawaguchi T, Sofue T, Shimizu S, et al. A digest of the Evidence-Based Clinical Practice Guideline for nephrotic syndrome 2020. Clin Exp Nephrol. 2021;25:1277–85. https://doi.org/10.1007/s10157-021-02098-5.
Wada T, Shimizu S, Koizumi M, Sofue T, Nishiwaki H, Sasaki S, et al. Japanese clinical practice patterns of primary nephrotic syndrome 2021: a web-based questionnaire survey of certified nephrologists. Clin Exp Nephrol. 2023. https://doi.org/10.1007/s10157-023-02366-6.
Ivanov A. Barriers to the introduction of new medical diagnostic tests. Lab Med. 2013 Cited 2023 May 18; 44:e132–6. https://academic.oup.com/labmed/article-abstract/44/4/e132/2505102.
Japan post; 2023. ZIP Code Data Download/Explanation of ZIP Code Data (in Japanese) [Internet] Accessed 2023 Jun 15. https://www.post.japanpost.jp/zipcode/dl/readme.html. Japan Post Co. Ltd.
Japan post. ZIP code data download / Explanation of individual code data for big business offices (in Japanese) [Internet]; 2023 Accessed 2023 Jun 15. https://www.post.japanpost.jp/zipcode/dl/jigyosyo/readme.html. Japan Post Co. Ltd.
Official statistics of Japan. Dataset list / census / 2020 key results by prefecture and municipality (in Japanese) [Internet]; 2022. {Statistics Bureau, Ministry of Internal Affairs and Communications} Accessed 2023 Jun 15. https://www.e-stat.go.jp/stat-search/files?page=1&layout=datalist&toukei=00200521&tstat=000001049104&cycle=0&tclass1=000001049105&tclass2val=0.
Cummings P, McKnight B. Analysis of matched cohort data. Stand Genomic Sci. 2004;4:274–81. https://doi.org/10.1177/1536867X0400400305.
Hanley JA, Negassa A, Edwardes MDD, Forrester JE. Statistical analysis of correlated data using generalized estimating equations: an orientation. Am J Epidemiol. 2003;157:364–75. https://doi.org/10.1093/aje/kwf215.
Naimi AI, Whitcomb BW. Estimating risk ratios and risk differences using regression. Am J Epidemiol. 2020;189:508–10. https://doi.org/10.1093/aje/kwaa044.
Akiyama S, Akiyama M, Imai E, Ozaki T, Matsuo S, Maruyama S. Prevalence of anti-phospholipase A2 receptor antibodies in Japanese patients with membranous nephropathy. Clin Exp Nephrol. 2015;19:653–60. https://doi.org/10.1007/s10157-014-1054-2.
Gupta DM, Boland RJ Jr, Aron DC. The physician’s experience of changing clinical practice: a struggle to unlearn. Implement Sci. 2017;12:28. https://doi.org/10.1186/s13012-017-0555-2.
Eba J, Nakamura K. Overview of the ethical guidelines for medical and biological research involving human subjects in Japan. Jpn J Clin Oncol. 2022;52:539–44. https://doi.org/10.1093/jjco/hyac034.
Acknowledgements
This study was supported in part by the Grants-in-Aid for Intractable Renal Diseases Research, Research on Rare and Intractable Diseases, and Health and Labor Sciences Research Grants from the Ministry of Health, Labor, and Welfare of Japan (ID 20FC1045). This funder had no role in the design, conduct, or reporting of the study.The authors would like to thank Editage (www.editage.jp) for English language editing.
Author information
Authors and Affiliations
Contributions
Study concept and design: S Sasaki, S Shimizu, TW, and NK. Data collection: TW, S Shimizu, and NK. Data analysis: S Sasaki, S Shimizu, and NK. Data interpretation and manuscript preparation: S Sasaki, S Shimizu, IN, YM, MK, HN, TS, TI, NK, and TW.
Corresponding author
Ethics declarations
Conflicts of interest
Honoraria: Noriaki Kurita (GlaxoSmithKline).
Ethical approval
This study was an anonymous survey of healthcare professionals to describe the practice of primary nephrotic syndrome and was considered outside the scope of the ethical review according to the Ethical Guidelines for Medical and Biological Research Involving Human Subjects [14]. The possibility of academic publication of the survey results was described at the beginning of the questionnaire and only those who provided consent to complete the survey were included.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
About this article
Cite this article
Sasaki, S., Shimizu, S., Nakaya, I. et al. Preference for anti-phospholipase A2 receptor antibody assay in patients with suspected membranous nephropathy: a survey study on medical practice after publication of Japanese Guidelines for Nephrotic Syndrome 2020. Clin Exp Nephrol (2024). https://doi.org/10.1007/s10157-024-02462-1
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s10157-024-02462-1