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Abstract: TH-PO536

A Case of Anti-PLA2R Antibody Positive Membranous Nephropathy Diagnosed in Pregnancy with Antibody Transfer to Infant

Session Information

  • Trainee Case Reports - I
    October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Trainee Case Reports

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Beers, Kelly H., Icahn School of Medicine at Mt. Sinai, New York, New York, United States
  • Patel, Niralee, Icahn School of Medicine at Mt. Sinai, New York, New York, United States
  • Dijanic, Amanda, Icahn School of Medicine at Mt. Sinai, New York, New York, United States
  • Sharma, Shuchita, Icahn School of Medicine at Mt. Sinai, New York, New York, United States
Introduction

Phospholipase A2 receptor (PLA2R) antibody is a pathogenic agent found in 70-80% of patients with primary membranous nephropathy (MN). Whether anti-PLA2R Ab is transmitted from maternal to fetal circulation remains unknown. We report a case of nephrotic syndrome during pregnancy with elevated anti-PLA2R Ab level in maternal serum, and subsequent detection of high levels of antibody in the infant, suggesting that anti-PLA2R Ab likely crosses the placenta.

Case Description

A 33 year old woman was transferred to our medical center at 28 weeks of gestation for ongoing management of pregnancy complicated by nephrotic syndrome. The patient had been diagnosed with the nephrotic syndrome at approximately 16 weeks of gestation based on edema, hypoalbuminemia (0.9g/dL), and 6g of protein on 24 hour urine collection. She had no known history of kidney disease. On arrival to our institution, serum creatinine (Cr) was at her baseline of 0.6 mg/dL with albumin 0.4g/dL. Anti-PLA2R Ab levels were found to be elevated at 479.6 RU/mL. A presumptive diagnosis of primary MN was made and renal biopsy was deferred due to her advanced gestation. Pt remained in the hospital for the duration of her pregnancy and underwent successful diuresis documented by 80 pound weight loss and significant improvement in her edema. She had successful delivery of a male baby at 34 weeks 3 days of gestation. 24 hour urine collection from the patient immediately following delivery showed 12g proteinuria. Cr remained stable throughout the admission. Anti-PLA2R Ab was measured in both mother and baby immediately post-delivery with values of 405.1 and 43.1 RU/mL, respectively.

Discussion

This case suggests that anti-PLA2R Ab crosses the placenta to reach fetal circulation. Whether this results in renal disease in the baby is unclear, though there are case reports of fetal morbidity associated with maternal neutral endopeptidase deficiency leading to congenital membranous nephropathy. Children of mothers with primary MN during pregnancy should be monitored pre- and post-natally for signs of renal disease mediated by Anti-PLA2R Ab.