Primary membranous nephropathy with concomitant IgA nephropathy

Area of Science:

• Nephrology
• Immunology
• Glomerular Diseases

Background:

• Membranous nephropathy (MN) is a common autoimmune glomerulonephritis, often IgG4-related, targeting phospholipase A2 receptors (anti-PLA2R) or THSD7A.
• IgA nephropathy is a prevalent autoimmune glomerular disease with a wide clinical spectrum.

Observation:

• A rare case of concomitant IgA nephropathy and primary MN in a single patient is presented.
• The patient exhibited significant proteinuria (7.5-8 g/g) and detectable anti-PLA2R antibodies.
• Serum creatinine remained within normal limits throughout the observation period.

Findings:

• Successful treatment was achieved using a combination of renin-angiotensin-aldosterone blockade, corticosteroids, and calcineurin inhibitors.
• Anti-PLA2R antibody levels decreased with effective treatment.
• This case underscores the successful management of a complex dual glomerular pathology.

Implications:

• Clinicians should consider the possibility of multiple glomerular disorders in patients presenting with atypical glomerulonephritis.
• Awareness of concomitant diseases can lead to more accurate diagnosis and tailored treatment strategies.
• This case expands the understanding of managing complex autoimmune kidney diseases.