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The utility of phospholipase A2 receptor antibody in pregnancy: A case report
Alessandra Orsillo1,2, Nishanta Tangirala1,2,3, Shilpanjali Jesudason1,2
1Central Northern Adelaide Renal and Transplantation Service, Adelaide, South Australia.
Primary membranous nephropathy remains a rare but challenging condition to manage in pregnancy. We present a case of an unplanned pregnancy in a 35-year-old woman with PLA2R-antibody positive membranous nephropathy, who had demonstrated serological response to rituximab given three months prior to pregnancy (PLA2R 115 IUmL reducing to 2 IU/mL, normal <13.9 IU/mL)). Throughout pregnancy, serial measurements of proteinuria and PLA2R-antibodies were used to understand disease activity and inform the decision to escalate treatment. Delivery of a healthy male infant occurred at 34 weeks, due to threatened pre-eclampsia and reduced fetal growth. There was evidence of trans-placental transfer of antibodies (15.2 IU/mL - normal <13.9 IU/mL) but no associated nephrotic syndrome in the infant. This case highlights the potential of PLA2R antibody as a diagnostic and monitoring tool during pregnancy, and adds to a small body of literature around the consequences of fetal-maternal transfer of the PLA2R antibody.
Primary membranous nephropathy remains a rare but challenging condition to manage in pregnancy. We present a case of an unplanned pregnancy in a 35-year-old woman with PLA2R-antibody positive membranous nephropathy, who had demonstrated serological response to rituximab given three months prior to pregnancy (PLA2R 115 IUmL reducing to 2 IU/mL, normal <13.9 IU/mL)). Throughout pregnancy, serial measurements of proteinuria and PLA2R-antibodies were used to understand disease activity and inform the decision to escalate treatment. Delivery of a healthy male infant occurred at 34 weeks, due to threatened pre-eclampsia and reduced fetal growth. There was evidence of trans-placental transfer of antibodies (15.2 IU/mL - normal <13.9 IU/mL) but no associated nephrotic syndrome in the infant. This case highlights the potential of PLA2R antibody as a diagnostic and monitoring tool during pregnancy, and adds to a small body of literature around the consequences of fetal-maternal transfer of the PLA2R antibody.
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