Distinguishing signal from noise: a new era of autoantibody testing in podocytopathies requires thoughtful approaches.

Abstract

Anti-nephrin antibodies have emerged as a highly anticipated pathogenic mechanism in diffuse podocytopathies in acute nephrotic syndrome. Testing for circulating antibodies offers great promise as an adjunct diagnostic to confirm immunologic activity in patients with new-onset, relapsing or recurring disease. Published in this issue, Shu et al. provide additional supportive evidence for establishing this mechanism as an important cause of nephrotic syndrome by studying a large Chinese patient cohort, including a particularly large number of adult patients with diffuse podocytopathy. Beyond querying anti-nephrin, they provide important data that inform about limitations of anti-nephrin serologic assays, discussed in this commentary.