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Primary membranous nephropathy — RCPSC IM MCQ

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HardNephrologyPrimary membranous nephropathyRCPSC IM

A 56-year-old man has oedema, albumin 22 g/L, urine protein-creatinine ratio 760 mg/mmol, and preserved eGFR. PLA2R antibody is strongly positive and kidney biopsy confirms membranous nephropathy. After 6 months of optimized supportive therapy, proteinuria remains nephrotic and albumin is falling. What is the most appropriate next step?

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Correct answer: D — Start immunosuppressive therapy such as rituximab after risk assessment

Persistent high-risk primary membranous nephropathy despite optimized supportive care warrants immunosuppressive therapy, commonly rituximab-based, after individualized risk and infection assessment.

Reference: KDIGO glomerular disease guidance