skip to main content

Membranous nephropathy — ESENeph MCQ

Instant feedback + full explanation. One question, done properly.

ModerateGlomerulonephritisMembranous nephropathyESENeph

A 63-year-old woman presents with new oedema and foamy urine. Serum albumin is 21 g/L, creatinine 92 micromol/L and urine PCR is 780 mg/mmol. Urinalysis shows protein 4+ and blood negative; anti-PLA2R antibody is positive. She has no diabetes and renal ultrasound is normal. What is the most likely diagnosis?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Primary membranous nephropathy

Nephrotic syndrome with positive anti-PLA2R antibody in an older adult is most consistent with primary membranous nephropathy. Minimal change disease may present with nephrotic syndrome but anti-PLA2R positivity is not expected. FSGS and amyloid can cause heavy proteinuria but the serological result makes membranous nephropathy the best answer. The pearl is that membranous nephropathy carries thrombotic risk, particularly when serum albumin is very low.

Reference: KDIGO 2021 Glomerular Diseases Guideline