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MN Immunological vs Clinical Remission — ESENeph MCQ

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HardGlomerulonephritisMN Immunological vs Clinical RemissionESENeph

A 55-year-old man with PLA2R-positive membranous nephropathy is on Rituximab. At 3 months, anti-PLA2R antibodies are undetectable but proteinuria persists at 4 g/day. What is the most appropriate interpretation?

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Correct answer: B — Immunological remission precedes clinical remission; continue monitoring proteinuria

Disappearance of anti-PLA2R antibodies (immunological remission) typically precedes clinical remission (proteinuria reduction) by weeks to months. KDIGO 2021 GN guideline states that clinical response to Rituximab may take up to 12-24 months. Persistent proteinuria in the setting of immunological remission does not constitute treatment failure. Monitoring should continue with expectation of proteinuria improvement.

Reference: KDIGO 2021 – Glomerular Disease Guideline