A 27-year-old man is brought to the physician because of swelling of his face and legs for 5 days. He has been healthy except for an episode of sore throat 2 weeks ago. His temperature is 37.0°C (98.6°F), pulse is 90/min, and blood pressure is 145/87 mm Hg. Examination shows generalized edema. he abdomen is soft and nontender. Serum creatinine is 1.1 mg/dL. Urinalysis shows 4+ protein, 0-3 leukocytes/hpf, and oval fat bodies. Serum contains IgG4 antibodies to the phospholipase A2 receptor (PLA2R), a transmembrane protein abundant on podocytes. Which of the following is the most likely diagnosis?

Question

A 27-year-old man is brought to the physician because of swelling of his face and legs for 5 days. He has been healthy except for an episode of sore throat 2 weeks ago. His temperature is 37.0°C (98.6°F), pulse is 90/min, and blood pressure is 145/87 mm Hg. Examination shows generalized edema. he abdomen is soft and nontender.  Serum creatinine is 1.1 mg/dL.  Urinalysis shows 4+ protein, 0-3 leukocytes/hpf, and oval fat bodies.  Serum contains IgG4 antibodies to the phospholipase A2 receptor (PLA2R), a transmembrane protein abundant on podocytes.  Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

Eductional Objective: Primary (idiopathic) membranous nephropathy is associated with IgG4 antibodies to the phospholipase A2 receptor, which might play a role in development of the disease.  Antibody titers are useful for diagnosis and correlate with disease activity.

A 27-Year-Old Man Is Brought to the Physician Because of Swelling