A 55-year-old man develops nephrotic-range proteinuria (5.8 g/day) with hypoalbuminaemia and oedema. Serology shows a positive serum anti-phospholipase A2 receptor antibody at high titre. Complement levels are normal. Which statement about his condition is correct?
- A He most likely has secondary membranous nephropathy due to malignancy
- B The antibody indicates lupus nephritis class V
- C High-titre anti-PLA2R antibody supports primary membranous nephropathy ✓
- D A positive anti-PLA2R titre excludes the need for kidney biopsy
Correct answer: C. High-titre anti-PLA2R antibody supports primary membranous nephropathy
Explanation
Anti-PLA2R antibodies are found in about 70 to 80 percent of patients with primary (idiopathic) membranous nephropathy and are rare in secondary forms. High titres correlate with disease activity and predict relapse, so serial monitoring guides therapy. The distractor about biopsy fails because biopsy remains required to confirm stage and exclude other lesions; the antibody supports but does not replace histology.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.