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Membranous Nephropathy — ESENeph MCQ

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ModerateGlomerulonephritisMembranous NephropathyESENeph

A 45-year-old man presents with nephrotic syndrome. Anti-PLA2R antibodies are strongly positive at 250 RU/mL. eGFR is 72 mL/min/1.73m2, serum albumin 18 g/L. Kidney biopsy confirms membranous nephropathy with PLA2R-positive staining. He has been on maximum dose ACE inhibitor for 3 months with persistent nephrotic-range proteinuria. What is the most appropriate treatment?

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Correct answer: E — Rituximab

KDIGO 2021 glomerular disease guideline recommends Rituximab as first-line immunosuppressive therapy for patients with membranous nephropathy at moderate-to-high risk of progression. High anti-PLA2R titres (>150 RU/mL) may reduce rituximab efficacy relative to cyclophosphamide, but rituximab remains first-line due to its favourable safety profile. Cyclophosphamide plus glucocorticoids is an alternative, particularly in very high risk. CNI monotherapy is not recommended.

Reference: KDIGO 2021 – Clinical Practice Guideline for Glomerular Diseases