Patient is a 55-year-old woman with biopsy proven Membranous GN, a few years prior to current presentation, who underwent the modified Ponticelli regimen after a period of maximal antiproteinuric therapy and observation period for spontaneous remission. At that time, she had undergone age appropriate cancer screenings, all of which were negative. About 4 months into treatment she showed significant improvement with complete resolution of her severe edema, improvement of albumin to 3 g/dl (she was about 1.5 g/dl at the start of treatment) and proteinuria down to 2 grams from a peak of about 12 grams on spot urine. Unfortunately, she was lost to follow up and showed up again 6 months after treatment completion with a complete relapse. She was re-biopsied (see below).
Laboratory and other data:
Serum PLA2R antibody negative.