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Secondary membranous nephropathy (HBV) — MCCQE Part 1 MCQ

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HardProteinuriaSecondary membranous nephropathy (HBV)MCCQE Part 1

A 55-year-old man with hepatitis B has nephrotic-range proteinuria. Biopsy: membranous nephropathy with subepithelial deposits. PLA2R antibody negative. Most likely aetiology?

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Correct answer: A — Secondary membranous nephropathy from HBV

PLA2R-negative membranous + active HBV = secondary MN. Treat underlying HBV. Other secondary causes: malignancy, SLE, drugs (NSAIDs, gold). PLA2R+ favours primary MN.

Reference: Canadian Nephrology / KDIGO Guidelines