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Primary membranous nephropathy — ABIM Board MCQ

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ModerateNephrologyPrimary membranous nephropathyABIM Board

A 58-year-old man has edema and nephrotic-range proteinuria. Creatinine is 1.0 mg/dL, albumin is 2.4 g/dL, urine protein-creatinine ratio is 8.1 g/g, and anti-PLA2R antibody is positive. Hepatitis B, hepatitis C, HIV testing, and age-appropriate cancer screening are negative. Kidney biopsy confirms membranous nephropathy. Which of the following is the most likely cause?

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Correct answer: B — Primary autoimmune membranous nephropathy

Anti-PLA2R positivity strongly supports primary membranous nephropathy. Secondary causes such as malignancy, infections, drugs, and lupus should be assessed, but the serologic pattern here favors primary disease.

Reference: KDIGO Glomerular Diseases Guideline