Nephrology: membranous nephropathy: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

General Medicine · Nephrology: membranous nephropathy

Sample item

A 52-year-old man has oedema and 6 g/day proteinuria with serum albumin 2.1 g/dL. Complement levels are normal. Serum anti-phospholipase A2 receptor antibodies are positive. What would electron microscopy of the kidney show?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Subepithelial immune deposits with spike formation of the basement membrane

Anti-PLA2R antibodies identify primary membranous nephropathy, the commonest cause of nephrotic syndrome in adults. Immune complexes form on the subepithelial side of the basement membrane, which then lays down new matrix between them, producing spikes on silver stain. Renal vein thrombosis is a recognised complication, and secondary causes include hepatitis B, malignancy and lupus.

Option by option

  • A. Subendothelial deposits with mesangial interposition

    Subendothelial deposits with mesangial interposition describe membranoproliferative glomerulonephritis.

  • B. Subepithelial immune deposits with spike formation of the basement membrane (correct)

    Correct. Subepithelial deposits with spikes are the hallmark of membranous nephropathy.

  • C. Splitting and lamellation of the basement membrane

    Splitting and lamellation of the basement membrane is typical of Alport syndrome.

  • D. Diffuse effacement of podocyte foot processes without deposits

    Foot process effacement without deposits describes minimal change disease.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Subepithelial immune deposits with spike formation of the basement membrane. Anti-PLA2R antibodies identify primary membranous nephropathy, the commonest cause of nephrotic syndrome in adults.

Why is "Subendothelial deposits with mesangial interposition" not the answer?

Subendothelial deposits with mesangial interposition describe membranoproliferative glomerulonephritis.

Why is "Splitting and lamellation of the basement membrane" not the answer?

Splitting and lamellation of the basement membrane is typical of Alport syndrome.

Why is "Diffuse effacement of podocyte foot processes without deposits" not the answer?

Foot process effacement without deposits describes minimal change disease.

What concept does this question test?

It tests Nephrology: membranous nephropathy in General Medicine. Immune complexes form on the subepithelial side of the basement membrane, which then lays down new matrix between them, producing spikes on silver stain. Renal vein thrombosis is a recognised complication, and secondary causes include hepatitis B, malignancy and lupus.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Nephrology: membranous nephropathy?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.