A 52-year-old man presents with edema and proteinuria of 6 g/day. Renal biopsy shows thickened capillary walls with granular subepithelial IgG deposits on immunofluorescence and a 'spike and dome' appearance on silver stain. Serum antibodies against phospholipase A2 receptor are strongly positive. This finding supports which diagnosis?

• A Primary (idiopathic) membranous nephropathy ✓
• B Secondary membranous nephropathy from hepatitis B
• C Lupus nephritis class V
• D Membranoproliferative glomerulonephritis

Explanation

Anti-phospholipase A2 receptor (PLA2R) antibodies are detectable in about 70 to 80 percent of patients with primary membranous nephropathy and are considered diagnostic of the idiopathic form. Secondary membranous nephropathy (hepatitis B, malignancy, drugs such as NSAIDs) and lupus class V are characteristically PLA2R negative. MPGN is excluded by the subepithelial rather than subendothelial or mesangial deposit location.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.