Renal: membranous nephropathy: practice question

A Pathology 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.

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Pathology · Renal: membranous nephropathy

Sample item

A 45-year-old man has nephrotic-range proteinuria. Light microscopy shows uniformly thickened glomerular capillary walls without hypercellularity, and silver stain shows spikes projecting from the basement membrane. Which target of circulating autoantibodies is most often responsible in the primary form?

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

The answer and the reasoning

A. Phospholipase A2 receptor on podocytes

Primary membranous nephropathy is the commonest cause of nephrotic syndrome in non-diabetic adults. Most patients have IgG4 autoantibodies against the podocyte phospholipase A2 receptor, which forms subepithelial deposits that provoke basement membrane spikes. Secondary causes include hepatitis B, lupus, drugs and solid tumours, so older patients need malignancy screening.

Option by option

  • A. Phospholipase A2 receptor on podocytes (correct)

    Correct. Anti-PLA2R autoantibodies are the main marker of primary membranous nephropathy.

  • B. Proteinase 3 in neutrophils

    Proteinase 3 is the target of c-ANCA in granulomatosis with polyangiitis.

  • C. Alpha-3 chain of type IV collagen

    The alpha-3 chain of type IV collagen is the target in anti-GBM disease, which causes crescentic nephritis.

  • D. Complement C3 convertase

    C3 nephritic factor stabilises C3 convertase in dense deposit disease and is not the membranous target.

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.

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Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is A, Phospholipase A2 receptor on podocytes. Primary membranous nephropathy is the commonest cause of nephrotic syndrome in non-diabetic adults.

Why is "Proteinase 3 in neutrophils" not the answer?

Proteinase 3 is the target of c-ANCA in granulomatosis with polyangiitis.

Why is "Alpha-3 chain of type IV collagen" not the answer?

The alpha-3 chain of type IV collagen is the target in anti-GBM disease, which causes crescentic nephritis.

Why is "Complement C3 convertase" not the answer?

C3 nephritic factor stabilises C3 convertase in dense deposit disease and is not the membranous target.

What concept does this question test?

It tests Renal: membranous nephropathy in Pathology. Most patients have IgG4 autoantibodies against the podocyte phospholipase A2 receptor, which forms subepithelial deposits that provoke basement membrane spikes. Secondary causes include hepatitis B, lupus, drugs and solid tumours, so older patients need malignancy screening.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 Renal: membranous nephropathy?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology 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.