Membranous nephropathy associated with pregnancy: an anti-phospholipase A2 receptor antibody-positive case report
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Pregnancy and membranous nephropathy (MN) can occur concurrently with nephrotic syndrome. However, the pathophysiology of MN associated with pregnancy remains unclear, including the involvement of anti-M-type phospholipase A2 receptor (PLA2R) antibody, the major antigen of idiopathic MN (iMN). A treatment for the condition is also not established. We present the case of a 43-year-old pregnant female with incidental proteinuria and hypoalbuminemia. We made a diagnosis of nephrotic syndrome at 11 week gestation. Renal biopsy revealed iMN using predominant granular staining of IgG4 along the glomerular basement membrane. No secondary cause was identified. Oral glucocorticoid therapy was started from 17 week gestation and induced complete remission at 28 week gestation. A healthy infant was born at 38 week gestation. Glucocorticoid therapy was stopped postpartum without MN relapse. Anti-PLA2R antibody was later found to be positive using serum reserved from before treatment. In conclusion, we presented the case of a pregnant woman with iMN and anti-PLA2R antibodies, whose nephrotic syndrome was successfully controlled with oral glucocorticoids to reach complete remission, even after tapering off the medication. Pregnancy per se might be associated with iMN onset.
KeywordsMembranous nephropathy Pregnancy Anti-phospholipase A2 receptor antibody Case report
We thank Dr. Shinichi Akiyama (Department of Nephrology, Graduate School of Medicine, Nagoya University) for measuring anti-PLA2R antibody, and Dr. Sachiko Minamiguchi (Department of Diagnostic Pathology, Kyoto University Hospital) for histological diagnosis. We also thank Mr. Chris Rowthorn for the English language review.
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Conflict of interest
M. Yanagita is on the advisory board of Astellas and receives research grants from Astellas, Chugai, Daiichi Sankyo, Fujiyakuhin, Kyowa Hakko Kirin, Mitsubishi Tanabe Pharma Corporation, MSD, Nippon Boehringer Ingelheim, and Torii. The other authors declare no conflicts of interest.
This study was exempted from institutional review board approval, because it was a case review. This article does not contain any studies with animals performed by any of the authors.
Written informed consent was obtained from the patient for publication of this case and any accompanying images.