MN Spontaneous Remission Rate — RACP Adult Medicine MCQ

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ModerateNephrologyMN Spontaneous Remission RateRACP Adult Medicine

A 65-year-old man develops new-onset nephrotic syndrome. Renal biopsy shows thickened glomerular capillary walls with 'spike and dome' pattern on silver stain. Immunofluorescence shows granular IgG and C3 deposition along the GBM. He has no systemic disease and anti-PLA2R is positive. What percentage of membranous nephropathy achieves spontaneous remission without immunosuppression?

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Correct answer: C — 100%

Approximately 30–40% of primary membranous nephropathy cases achieve spontaneous complete or partial remission without immunosuppressive treatment, particularly those with subnephrotic proteinuria or declining anti-PLA2R titres. This is why KDIGO recommends a 3–6 month observation period with supportive therapy (ACEi/ARB, statins, salt restriction) before commencing immunosuppression, UNLESS there are features of high risk (massive proteinuria >8 g/day with declining eGFR, or persistently high anti-PLA2R titres). Monitoring anti-PLA2R levels serially helps predict spontaneous remission (declining titres) vs need for immunosuppression (rising or persistently high titres).

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