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논문분류	춘계학술대회 초록집
제목	Early Serologic Response but Irreversible Renal Failure in Advanced PLA2R-Positive Membranous Nephropathy: Implications for Biopsy Timing
저자	Heewon Park
출판정보	2026; 2026(1):
키워드	membranous nephropathy, Anti-phospholipase A2 receptor
초록	Objectives: Anti-phospholipase A2 receptor (PLA2R) antibodies are reliable markers of disease activity in primary membranous nephropathy (MN). However, the relationship between serologic response and renal recovery may be limited in patients presenting with advanced chronic kidney disease (CKD). Methods: A 66-year-old man with hypertension, atrial fibrillation, and heart failure presented with progressive edema and dyspnea. Laboratory evaluation revealed nephrotic-range proteinuria (urine protein-to-creatinine ratio [UPCR] 13.4 g/g Cr) and advanced renal dysfunction (serum creatinine 3.7 mg/dL; estimated glomerular filtration rate [eGFR] 15 mL/min/1.73 m²). Two months earlier, serum creatinine was 3.4 mg/dL with negative anti-PLA2R antibody. At presentation, anti-PLA2R IgG was elevated to 95.2 RU/mL. Kidney biopsy demonstrated PLA2R-positive membranous nephropathy with significant chronic changes. Of 13 glomeruli, 6 (46%) were globally sclerotic and 5 (38%) showed segmental sclerosis. Approximately 50% of tubules exhibited interstitial fibrosis and tubular atrophy. Immunofluorescence revealed granular IgG (3+) and C3 (2+) along capillary walls. Results: Prednisolone 70 mg/day was initiated. Anti-PLA2R antibody titers decreased to 2.8 RU/mL and subsequently to 1.1 RU/mL within 6 weeks, indicating serologic remission. However, massive proteinuria persisted (UPCR up to 28 g/g Cr), and renal function did not recover. Hemodialysis was initiated due to refractory volume overload, and the patient remains on maintenance dialysis with gradual steroid tapering. Conclusion: This case highlights dissociation between early serologic remission and renal outcome in advanced PLA2R-positive MN with substantial chronic histologic damage. In patients with nephrotic-range proteinuria and advanced CKD, timely biopsy may help clarify etiology before irreversible structural injury predominates.
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