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PLA2R Negative MN THSD7A Secondary Investigation — ESENeph MCQ

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HardGlomerulonephritisPLA2R Negative MN THSD7A Secondary InvestigationESENeph

Kidney biopsy shows membranous nephropathy. Serum anti-PLA2R is negative and routine immunofluorescence raises no lupus pattern. Before labelling this primary disease, which investigation strategy is most appropriate?

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Correct answer: D — Antigen-directed review plus targeted secondary-cause evaluation

Explanation lettering: C = shown as A · E = shown as B · D = shown as C · B = shown as D · A = shown as E

B is correct. Negative circulating anti-PLA2R broadens rather than closes the differential. Pathology review with antigen-directed staining or relevant serology can refine the phenotype, while history and targeted testing address autoimmune disease, infection, drugs and age-appropriate malignancy risk. A exposes a patient to toxic therapy before classification and risk assessment. C treats malignancy as the only secondary cause and uses indiscriminate imaging. D delays a necessary work-up because serum and tissue PLA2R results are not interchangeable. Immunosuppression is then based on kidney risk, spontaneous-remission probability and the identified cause, not seronegativity alone.

Reference: KDIGO 2021 guideline for glomerular diseases: https://kdigo.org/wp-content/uploads/2024/05/KDIGO-2021-Glomerular-Diseases-Guideline_English_2024-Chapter-Updates.pdf