[Primary membranous nephropathy presenting as relapsing ascites].

Area of Science:

• Nephrology
• Immunology

Background:

• Ascites is a frequent complication of liver cirrhosis.
• Nephrotic syndrome can manifest with ascites, often alongside heart or liver disease and generalized edema.
• Primary membranous nephropathy (MN) is a leading cause of nephrotic syndrome in adults.

Observation:

• A 64-year-old male patient presented with recurrent ascites without other signs of edema or evidence of heart or liver disease.
• Diagnostic investigations revealed primary membranous nephropathy (MN).
• The patient tested positive for the autoantibody anti-PLA2R.

Findings:

• The patient's ascites resolved completely following immunotherapy.
• This case demonstrates a direct link between anti-PLA2R-associated primary MN and isolated ascites.
• Anti-PLA2R and anti-TSHD7A antibodies are implicated in diagnosing primary versus secondary MN.

Implications:

• Membranous nephropathy should be considered in the differential diagnosis of ascites, even in the absence of typical nephrotic syndrome features.
• Anti-PLA2R antibody testing is crucial for diagnosing and managing anti-PLA2R-associated MN.
• Targeting anti-PLA2R antibodies with immunotherapy offers a potential treatment strategy for ascites in MN patients.