In an adult with nephrotic-range proteinuria and preserved kidney function, a positive PLA2R antibody supports primary membranous nephropathy strongly enough to change what happens next - including, in some patients, whether a biopsy is needed at all.
The practical error is ordering it after the histology returns, as confirmation. Sent at presentation, it arrives in time to inform the biopsy discussion and, when negative, prompts the search for a secondary cause - malignancy, hepatitis B, lupus, drugs - while the patient is still being worked up rather than weeks later.
The titre is the second half of the value. A baseline level gives you something to follow: immunological remission precedes proteinuric remission by months, so a falling antibody in a patient whose protein has not moved is a reason to keep going rather than to switch therapy.
- Send PLA2R antibody at presentation of adult nephrotic syndrome, not after the biopsy
- Record the baseline titre - it is the reference for every later measurement
- A negative result should trigger a search for secondary causes, including malignancy screening
- Immunological remission precedes proteinuric remission; do not switch therapy on protein alone
- Repeat the titre at six months on treatment before judging response
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for nephrology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free