Rapidly Progressing Primary Membranous Nephropathy in a Hispanic Male With Elevated Levels of Anti-phospholipase A2 Receptor Antibodies

A 49-year-old Hispanic male presented to the Emergency Department with progressively worsening swelling in his extremities for the past two months. Physical examination was significant for diffuse edema, with concomitant initial laboratory tests revealing hypoalbuminemia, hypercholesteremia, and proteinuria. A renal biopsy was performed, and the histopathology confirmed a diagnosis of membranous nephropathy through immunofluorescence and electron microscopy. Anti-phospholipase A2 receptor (anti-PLA2R) antibodies were detected on immunofluorescence, as well as high levels being discovered in the patient's serum, indicating a diagnosis of primary membranous nephropathy. The patient underwent adequate diuresis and was discharged. The patient presented six months later due to severe anasarca with laboratory tests indicating a rapid decline in renal function. He was then started on immunosuppressive therapy. Our rare case of a Hispanic male presenting with rapidly deteriorating renal function secondary to primary membranous nephropathy seeks to highlight the possibility of using anti-PLA2R antibodies as a marker for early initiation of immunosuppressive therapy as well as to encourage additional research on the course of disease progression in the Hispanic population.