A rare case of PLA2R- and THSD7A-positive idiopathic membranous nephropathy

A rare case of PLA2R- and THSD7A-positive idiopathic membranous nephropathy

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ProLogic Parts ABSTRACT Idiopathic membranous nephropathy (IMN) is a frequent cause of nephrotic syndrome in adults.In terms of etiology, the condition may be categorized as primary/idiopathic or secondary.Literature on the pathophysiology of IMN has indicated the presence of autoantibodies (PLA2R and THSD7A) directed against podocyte antigens.

The detection of antibodies against a domain favors IMN.The presence of autoantibodies against one of the domains would in theory exclude the possibility of there being autoantibodies against the other domain.However, cases of patients with PLA2R- and THSD7A-positive disease have been recently reported, showing that antibodies against two targets may be concomitantly produced via yet unknown Kidney / Urinary Support pathophysiological mechanisms.

This study reports the case of a 46-year-old male patient with nephrotic-range proteinuria, hematuria, hypoalbuminemia, and hypercholesterolemia submitted to biopsy and histopathology examination (LM, IF, IHC, and EM) eventually diagnosed with PLA2R- and THSD7A-positive IMN associated with IgA nephropathy, stressing our experience with the use of IgG subclasses, PLA2R, and THSD7A in the workup for MN and the relevance of adopting a broad and adequate approach to elucidating and acquiring knowledge of the pathophysiology of IMN.