Abstract: TH-PO0810
What Should Be the Approach in Relapsed Primary Membranous Nephropathy? A Case Report
Session Information
- Glomerular Case Reports: Membranous, PGN, GBM, and More
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Tahir, Muhammad Khalid, New York Medical College, Metropolitan Hospital, New York, New York, United States
- Ahmad, Saadiyah, Frontier Medical and Dental College, Abbottabad, N.W.F.P, Pakistan
- Chaudhari, Ashok P., New York Medical College, Metropolitan Hospital, New York, New York, United States
- Lee, Sunggeun, New York Medical College, Metropolitan Hospital, New York, New York, United States
Introduction
Primary membranous nephropathy (PMN) is characterized by the presence of circulating anti-phospholipase A2 receptor (PLA2R) antibodies and also deposition in renal tissue. This case report presents a relapse of PMN with negative anti-PLA2R serology but positive PLA2R staining on renal biopsy.
Case Description
A 56-year-old woman with a history of primary membranous nephropathy based upon kidney biopsy in June 2021 showing PLA2R antibodies both in serum and histopathology. She achieved remission following treatment with intravenous rituximab, characterized by loss of proteinuria and negative PLA2R serology. She experienced relapse in October 2024, when her albuminuria increased to 6270 mg, and decline in serum albumin to 3 g/dL but PLA2R serology remained negative. A kidney biopsy was performed that showed recurrent primary membranous nephropathy with positive PLA2R staining in histopathology, mild tubular atrophy, mild interstitial fibrosis, and focal moderate arteriosclerosis. She was treated again with rituximab and she attained complete remission with this treatment.
Discussion
In most cases of PMN, presence of PLA2R in serology and histopathology concurred; however, this case points to the potential for serology-biopsy discordance of PLA2R in PMN relapse. The negative PLA2R serology usually suggest to seek different etiologies of relapse other than PMN. The renal biopsy is performed to find the diagnosis and to guide the therapy specially in the PMN relapse. The good response to rituximab suggests that tissue-specific immune processes may remain active despite negative serology.
Conclusion: This case highlights the complexity of PMN in relapse with negative PLA2R serology. It underscores the worth of renal biopsy and disease activity assessment and decision making for treatment. Further studies are needed to unveil the mechanism of this discordance and enhanced management regimes for such cases.