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Membranous Nephropathy — RACP Adult Medicine MCQ

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ModerateNephrologyMembranous NephropathyRACP Adult Medicine

A 55-year-old woman presents with peripheral oedema, frothy urine, and serum albumin of 18 g/L. Urine protein is 12 g/day. Renal biopsy shows thickened glomerular basement membranes with subepithelial immune deposits on electron microscopy and positive staining for PLA2R antibodies. What is the diagnosis?

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Correct answer: B — Membranous nephropathy

Subepithelial immune deposits causing GBM thickening on electron microscopy with positive anti-PLA2R antibodies is pathognomonic for primary membranous nephropathy. PLA2R is positive in ~70–80% of primary MN. Treatment of moderate-to-high-risk MN includes rituximab (increasingly first-line) or cyclophosphamide-based regimens plus supportive therapy (ACEi/ARB, statins).

Reference: eTG – 2025 – Nephrology; KDIGO – 2021 – Glomerular Diseases Guidelines