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Membranous Nephropathy — ESENeph MCQ

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HardGlomerulonephritisMembranous NephropathyESENeph

A 35-year-old man presents with frothy urine, oedema, and albumin of 16 g/L. He has type 2 diabetes diagnosed 1 year ago with HbA1c 52 mmol/mol. Urine shows no haematuria. His anti-PLA2R antibodies are positive. What does this finding suggest?

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Correct answer: A — Primary membranous nephropathy coexisting with diabetes rather than diabetic nephropathy

Positive anti-PLA2R antibodies are highly specific (>95%) for primary membranous nephropathy. In a young patient with short duration diabetes, good glycaemic control, no retinopathy, and no haematuria, the nephrotic syndrome is more likely due to a primary glomerular disease than diabetic nephropathy. MN can coexist with diabetes. KDIGO 2021 states that a positive PLA2R serology with nephrotic syndrome and normal kidney function may be sufficient for diagnosis without biopsy, though biopsy may still be warranted to exclude coexisting diabetic nephropathy.

Reference: KDIGO 2021 – Glomerular Disease Guideline