Anti-PLA2R Antibody (Phospholipase A2 Receptor)

Antibodies against a protein on the kidney's filter cells. A positive result is strongly linked to primary membranous nephropathy, a cause of protein leaking into the urine.

AI-verified against cited sources. Awaiting expert reviewAlso called PLA2R, anti-PLA2R, PLA2R AbLOINC 73737-9

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What it is

Podocytes are cells that help the kidney's filters hold back protein. They carry a protein called the phospholipase A2 receptor (PLA2R). In primary membranous nephropathy, the immune system makes antibodies against PLA2R, and protein leaks into the urine. This test measures those antibodies. Most labs use an ELISA and report relative units per mL (RU/mL), and some use an immunofluorescence titer.

Why it matters

Anti-PLA2R antibodies are found in about 70% of people with primary membranous nephropathy, and a positive result is uncommon in other kidney conditions. Under the 2021 KDIGO guideline, as described in a 2023 review, a positive result in someone with typical nephrotic syndrome can mean a kidney biopsy is not needed to confirm the diagnosis. Levels also tend to follow how active the disease is, so clinicians repeat the test every 3 to 6 months to see how treatment is working. A negative result does not rule the condition out.

If it’s high

A result above your lab's cutoff is reported as positive. On the common ELISA, below 14 RU/mL is negative, 14 up to 20 is borderline and 20 or more is positive. A positive result is strongly linked to primary membranous nephropathy, but your clinician reads it together with your urine protein, kidney function and symptoms. In people who are already being followed, a falling level is read as a sign that the disease is calming down, and a level that stays high may lead to changes in the plan.

Common causes

A borderline result (14 up to 20 RU/mL on the common ELISA), which sits between negative and positive and is read with the rest of the picture
Primary (idiopathic) membranous nephropathy, a kidney condition with no other known cause
Rarely, a positive result in someone whose kidney disease has another main cause

What can help

Ask whether your antibody result and symptoms mean a kidney biopsy can be avoided, or whether a biopsy is still advised
Ask how often the antibody level should be rechecked
Ask whether other causes of membranous nephropathy, such as another autoimmune condition, need to be checked

Usual ranges

What labs print as the reference range, by who was tested. Ranges differ a little between labs, so the range on your own report is the one your result is judged against.

For adults: 0–13.9 RU/mL. Source: ARUP Laboratories, Journal of Nephrology, International Urology and Nephrology.

Adults (this one applies)0–13.9 RU/mL
Sources: ARUP Laboratories, Journal of Nephrology, International Urology and Nephrology

What can affect your result

Test method: ELISA gives a number, immunofluorescence gives a titer, and cutoffs differ by kit
Treatment: levels fall as the disease responds to treatment, and the level is used to guide follow-up
Not everyone with membranous nephropathy has this antibody: about 70% do
Methods differ: ELISA gives a number in RU/mL, immunofluorescence gives a titer, and cutoffs differ by kit.
Treatment lowers antibody levels, so a result taken during treatment is not comparable with one taken before it.

When to talk to a clinician

A positive anti-PLA2R result is not an emergency on its own. Talk with a clinician soon if you have foamy urine, swelling in the legs, ankles or around the eyes, or rapid weight gain from fluid. Get urgent care for a swollen, painful leg, sudden chest pain or trouble breathing, since conditions with heavy protein loss in the urine can raise the risk of blood clots.

Questions you could ask

What other tests will we use to track my progress?
Do my result and urine protein mean I need a kidney biopsy?
How often should we recheck the antibody level?
Should we look for other causes of protein in my urine?

Questions people ask

Does a positive result mean I have membranous nephropathy?

A positive result is strongly linked to it, especially when there is a lot of protein in the urine. Your clinician reads it with your other tests. Under current guidance, some people with a positive result and typical symptoms do not need a kidney biopsy, but others still do.

Can I have membranous nephropathy with a negative result?

Yes. About 70% of people with the primary form have these antibodies, so around 30% do not. Antibodies to other proteins and a kidney biopsy can help in that case.

What does a falling level mean?

In people being followed for membranous nephropathy, a falling antibody level is read as a sign that the disease is calming down. A level below 2 RU/mL on the ELISA is described as a complete immunological remission. Your clinician reads the number together with urine protein and kidney tests.

Show the science and sources

For clinicians and researchers

Anti-PLA2R antibodies are IgG autoantibodies against the M-type transmembrane phospholipase A2 receptor on podocytes. They are present in about 70% of patients with idiopathic membranous nephropathy (MN) with specificity close to 100%, and titers correlate with clinical status (reviewed in J Nephrol 2023). Detection is by ELISA (quantitative, RU/mL) or by indirect immunofluorescence (titer). In an Italian cohort of 495 biopsied patients (126 with idiopathic MN), a commercial ELISA had 61.1% sensitivity and 99.7% specificity at the manufacturer's 20 RU/mL positive cutoff, 63.5% and 99.7% at the 14 RU/mL borderline cutoff, and 83.3% and 95.1% at a cutoff of 2.7 RU/mL chosen from the ROC curve (J Nephrol 2021). A study of 229 patients in China found 65.3% sensitivity and 97.3% specificity at 14 RU/mL, 60.2% and 97.3% at 20, and 45.8% and 97.3% at 40 (Int Urol Nephrol 2016). The KDIGO 2021 glomerular diseases guideline, as summarized in a 2023 review, no longer requires a biopsy to diagnose MN when a patient with typical nephrotic syndrome has positive anti-PLA2R antibodies. Biopsy is still advised for an unusual immune profile such as a positive ANA, a lack of response to treatment, persistent nephrotic syndrome despite negative antibodies, or rapidly declining kidney function. The same review describes anti-PLA2R measured every 3 to 6 months during follow-up (more often at higher starting values), values below 2 RU/mL by ELISA as complete immunological remission, and anti-PLA2R above 50 RU/mL as one marker of higher risk, with the caveat that this cutoff is not validated. Antibodies to other podocyte or glomerular proteins (THSD7A, NELL-1, SEMA3B and others) have also been described in MN. Units, cutoffs and categories are assay-specific.

LOINC 73737-9 (primary), 81201-6, 82991-1, 108910-1. Specimen: serum.

Sources

KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases, Kidney International (2021)
From KDIGO 2012 towards KDIGO 2021 in idiopathic membranous nephropathy guidelines: what has changed over the last 10 years?, Journal of Nephrology (2023)
Diagnostic accuracy of anti-phospholipase A2 receptor (PLA2R) antibodies in idiopathic membranous nephropathy: an Italian experience, Journal of Nephrology (2021)
The accuracy of the anti-phospholipase A2 receptor antibody in the diagnosis of idiopathic membranous nephropathy: a comparison of different cutoff values as measured by the ELISA method, International Urology and Nephrology (2016)
Anti-Phospholipase A2 Receptor (PLA2R) Antibody, IgG by ELISA (test 3016767), ARUP Laboratories

AI-verified against cited sources. Awaiting expert review. Last reviewed 2026-10-03. How we build and check these pages.