Management and Treatment of Primary Membranous Nephropathy With a Positive PLA2R Marker

Membranous nephropathy due to a positive PLA2R marker is an idiopathic cause of membrane nephropathy, characterized as an autoimmune attack on the kidney at the PLA2R receptor. Autoantibodies attack the PLA2R receptor, leading to nephrotic syndrome and eventually leading to end-stage renal failure, as in our case. We present a case that involves a patient who presented to the nephrology clinic with nephrotic range proteinuria and a history of HIV. The biopsy was prompted by nephrotic syndrome, where we saw clear evidence of sclerotic and fibrotic damage along with positive anti-PLA2R antibodies. The patient was put on tacrolimus and cyclophosphamide to halt the damage, but the patient eventually had to be put on dialysis later on. What makes this case unique is the patient is dealing with both the PLA2R antibodies and HIV, which increases the complexity of the treatment and our understanding of what played a bigger role in kidney failure. It is unique cases like these that prompt us to research further about these pathologies and develop new treatment options that result in a better prognosis.