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Phospholipase A2 Receptor Antibody-Positive Pregnancy: A Case Report
Mala Sachdeva1, Laurence H Beck2, Ilene Miller1
1Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY.
Summary
Pregnancy with primary membranous nephropathy is possible but carries risks. Autoantibodies to M-type phospholipase A2 receptor (PLA2R) transfer to the fetus and appear in breast milk, necessitating close monitoring.
Area of Science:
- Nephrology
- Immunology
- Maternal-Fetal Medicine
Background:
- Primary membranous nephropathy (MN) in pregnancy presents complex clinical challenges.
- The role of M-type phospholipase A2 receptor (PLA2R) autoantibodies in pregnancy and postpartum outcomes remains unclear.
- Understanding PLA2R antibody dynamics is crucial for managing MN during gestation.
Observation:
- A case study followed a pregnant woman with primary MN and PLA2R antibodies.
- Clinical course, maternal and neonatal outcomes, and PLA2R antibody titers were monitored throughout pregnancy and postpartum.
- Transplacental transfer of PLA2R antibodies and their presence in breast milk were observed.
Findings:
- Pregnancy in women with PLA2R antibody-positive MN is feasible.
- Evidence of transplacental transfer of PLA2R antibodies from mother to fetus was documented.
- PLA2R antibodies were detected in breast milk, indicating transfer via breastfeeding.
Implications:
- Pregnancy with PLA2R-positive MN increases risks for both mother and fetus.
- A multidisciplinary approach is essential for optimal management.
- Close monitoring of mother and neonate during pregnancy and postpartum is critical.
