Nephrology and electrolytes: primary membranous nephropathy antibody: 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.

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General Medicine · Nephrology and electrolytes: primary membranous nephropathy antibody

Sample item

A 55-year-old man has nephrotic syndrome with no diabetes, lupus features or drug exposure. Renal biopsy shows diffuse thickening of glomerular capillary walls with subepithelial deposits and spikes on silver stain. Which serum antibody supports the primary form of this disease?

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

The answer and the reasoning

B. Anti-phospholipase A2 receptor antibody

Most primary membranous nephropathy is caused by autoantibodies against the podocyte M-type phospholipase A2 receptor. Its presence supports primary disease, and falling titres track remission. Secondary causes include hepatitis B, lupus, drugs and malignancy.

Option by option

  • A. Anti-proteinase 3 antibody

    Anti-proteinase 3 antibodies are linked to vasculitis, which gives a pauci-immune picture.

  • B. Anti-phospholipase A2 receptor antibody (correct)

    Correct. Anti-PLA2R antibodies are found in most primary membranous nephropathy.

  • C. Anti-glomerular basement membrane antibody

    Anti-GBM antibodies cause crescentic disease with linear IgG staining.

  • D. Anti-double-stranded DNA antibody

    Anti-dsDNA suggests lupus nephritis, which is a secondary cause.

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 General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Anti-phospholipase A2 receptor antibody. Most primary membranous nephropathy is caused by autoantibodies against the podocyte M-type phospholipase A2 receptor.

Why is "Anti-proteinase 3 antibody" not the answer?

Anti-proteinase 3 antibodies are linked to vasculitis, which gives a pauci-immune picture.

Why is "Anti-glomerular basement membrane antibody" not the answer?

Anti-GBM antibodies cause crescentic disease with linear IgG staining.

Why is "Anti-double-stranded DNA antibody" not the answer?

Anti-dsDNA suggests lupus nephritis, which is a secondary cause.

What concept does this question test?

It tests Nephrology and electrolytes: primary membranous nephropathy antibody in General Medicine. Its presence supports primary disease, and falling titres track remission. Secondary causes include hepatitis B, lupus, drugs and malignancy.

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 and electrolytes: primary membranous nephropathy antibody?

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.