PLA2R Immunological Relapse Pre-emptive Treatment — ESENeph MCQ

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HardGlomerulonephritisPLA2R Immunological Relapse Pre-emptive TreatmentESENeph

A 45-year-old man with membranous nephropathy achieves complete remission (proteinuria <0.3 g/day) after Rituximab. His anti-PLA2R antibodies are undetectable. Two years later, anti-PLA2R antibodies are detected again at rising titres but proteinuria remains <0.3 g/day. What does this indicate?

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Correct answer: E — Immunological relapse preceding clinical relapse – rising anti-PLA2R titres predict future proteinuria recurrence; pre-emptive retreatment with Rituximab before clinical relapse develops may be considered

Anti-PLA2R antibody monitoring post-treatment in MN provides a window of opportunity for pre-emptive intervention. Immunological relapse (antibody reappearance/rise) typically precedes clinical relapse (proteinuria recurrence) by 3-12 months. KDIGO 2021 GN guideline supports serial anti-PLA2R monitoring. Some centres practice pre-emptive Rituximab retreatment when antibodies rise before proteinuria recurs – potentially preventing the morbidity of full nephrotic relapse. This 'immunologically guided' treatment approach represents a shift toward precision nephrology in MN.

Reference: KDIGO 2021 – GN; Ruggenenti et al 2015 – PLA2R-Guided Treatment