A 48-year-old man presents with proteinuria of 6 g/day. Renal biopsy shows subepithelial immune deposits with spike formation. Serologic testing shows high titers of circulating antibodies against the M-type phospholipase A2 receptor. Which statement about this patient's condition is correct?

• A The presence of anti-PLA2R antibodies confirms secondary disease due to a malignancy
• B High anti-PLA2R titers predict spontaneous remission without therapy
• C Anti-PLA2R antibodies are found only in pediatric membranous nephropathy
• D Anti-PLA2R positivity indicates primary (idiopathic) membranous nephropathy ✓

Explanation

Autoantibodies against the phospholipase A2 receptor on podocytes identify primary membranous nephropathy and are absent in most secondary forms such as hepatitis D related, drug induced, or malignancy associated disease. Titers correlate with disease activity and fall before remission, so option B is wrong. Option A reverses the clinical meaning of the test, since secondary cases are typically PLA2R negative.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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