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PLA2R-negative MN — SCE Medical Oncology MCQ

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HardImmunotherapy & Targeted TherapyPLA2R-negative MNSCE Medical Oncology

A patient receiving nivolumab develops nephrotic syndrome. Biopsy shows membranous nephropathy and serum anti-PLA2R is negative. What is the correct causal interpretation?

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Correct answer: A — Investigate secondary membranous nephropathy; PLA2R negativity supports but does not prove an ICI cause

Explanation lettering: E = shown as D · D = shown as E

A is correct. ICI renal injury is most often tubulointerstitial nephritis but can include membranous nephropathy and other glomerular lesions. PLA2R negativity makes primary PLA2R-associated disease less likely and supports a secondary search; it is not a drug-specific biomarker. Active cancer itself, infection, autoimmune disease and other medicines remain competing causes, so timing, electron microscopy or antigen staining where available and the broader work-up determine attribution. The histological diagnosis is not erased by negative serum PLA2R.

Reference: SITC immune-checkpoint toxicity guideline: https://pubmed.ncbi.nlm.nih.gov/34172516/