About 70–80% of primary membranous nephropathy is associated with antibodies to the phospholipase A2 receptor (PLA2R). A positive serum anti-PLA2R in a patient with nephrotic syndrome and preserved kidney function strongly supports the diagnosis, and current KDIGO guidance accepts it in place of biopsy in selected patients.
Antibody levels also track disease activity: falling levels usually precede clinical remission, and rising levels can signal relapse. Always look for secondary causes, including infections such as hepatitis B, malignancy and drugs.
- Check serum anti-PLA2R in adults with nephrotic syndrome
- A positive result with preserved function may allow diagnosis without biopsy in selected patients
- Repeat antibody levels to monitor treatment response and relapse
- Screen for secondary causes such as hepatitis B, malignancy and drugs
Why it matters
Antibody levels change before proteinuria does, guiding treatment earlier.
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