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HBV-Associated Membranous Nephropathy — ESENeph MCQ

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ModerateGlomerulonephritisHBV-Associated Membranous NephropathyESENeph

A 50-year-old woman with known Hepatitis B (HBsAg positive) develops nephrotic syndrome. Kidney biopsy shows membranous nephropathy with mesangial IgA co-deposits. Anti-PLA2R is negative. What is the most likely diagnosis?

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Correct answer: C — Hepatitis B-associated membranous nephropathy – a secondary MN requiring antiviral treatment as the primary intervention

HBV-associated MN is a well-recognised secondary cause. Unlike primary MN (PLA2R-positive), HBV-MN is PLA2R-negative and may show mesangial IgA co-deposits (a clue to HBV involvement). HBe antigen or HBV antigens may be found in immune deposits on specialised staining. KDIGO 2021 GN guideline recommends antiviral therapy as the primary treatment – clearing or suppressing HBV often leads to MN remission. Immunosuppressive therapy carries risks of HBV reactivation and is generally avoided unless disease-specific treatment is failing.

Reference: KDIGO 2021 – GN Guideline (Infection-Related GN); EASL 2024 – HBV