A patient with membranous nephropathy is found to have anti-PLA2R antibodies. PLA2R (phospholipase A2 receptor) is expressed on which glomerular cell, and what type of immune deposits are seen on electron microscopy?

• A Mesangial cells; mesangial electron-dense deposits
• B Endothelial cells; subendothelial deposits
• C Parietal epithelial cells; intramembranous deposits
• D Podocytes; subepithelial electron-dense deposits with GBM spikes ✓

Explanation

PLA2R is expressed on podocytes. In primary membranous nephropathy, anti-PLA2R IgG4 binds to podocyte surface antigens, forming in-situ immune complexes that appear as subepithelial electron-dense deposits on EM. Silver stain shows GBM 'spikes' projecting between deposits. Anti-PLA2R is positive in ~70% of primary membranous nephropathy cases.

Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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