{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T14:02:04Z","timestamp":1784901724988,"version":"3.55.0"},"reference-count":18,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,7,10]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:p>Primary membranous nephropathy (PMN) in pregnancy is rare and poses significant risks including pre-eclampsia, preterm delivery, low birth weight and fetal death. Anti-phospholipase A2 receptor (PLA2R) antibodies are used to confirm diagnosis.<\/jats:p>\n                  <jats:p>We report a case of biopsy-confirmed PLA2R-positive but seronegative PMN in a woman in her late 20s with a dichorionic\u2013diamniotic twin pregnancy. Initial hypoalbuminaemia was attributed to intercurrent infection but was later recognised as nephrotic syndrome at 20+6\u2009weeks gestation. Renal biopsy at 21 weeks confirmed PMN with positive PLA2R and IgG4 staining, despite negative serum PLA2R antibodies.<\/jats:p>\n                  <jats:p>She was managed with tacrolimus and rituximab, with close monitoring and delivered viable twins via emergency caesarean at 33+3\u2009weeks following premature rupture of membranes. Both maternal disease and neonatal outcomes were favourable. This case highlights the challenges in diagnosing and managing seronegative PMN during pregnancy and supports the role of renal biopsy and rituximab in selected patients.<\/jats:p>","DOI":"10.1136\/bcr-2026-272147","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T13:10:22Z","timestamp":1784898622000},"page":"e272147","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Serum PLA2R-negative, biopsy-proven PLA2R-positive primary membranous nephropathy in a dichorionic\u2013diamniotic twin pregnancy"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-9370-0486","authenticated-orcid":false,"given":"Abhik","family":"Kansal","sequence":"first","affiliation":[{"name":"Department of Nephrology, Grampians Health, Ballarat, Victoria, Australia"},{"name":"Deakin University School of Medicine, Geelong, Victoria, Australia"},{"name":"Department of Nephrology, Monash Medical Centre, Clayton, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lyra","family":"Meehan","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Grampians Health, Ballarat, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Metta","family":"MacNeil","sequence":"additional","affiliation":[{"name":"Dorevitch Pathology, Heidelberg, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha","family":"Frawley","sequence":"additional","affiliation":[{"name":"Deakin University School of Medicine, Geelong, Victoria, Australia"},{"name":"Women's and Children\u2019s, Grampians Health, Ballarat Central, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9692-8118","authenticated-orcid":false,"given":"David","family":"Langsford","sequence":"additional","affiliation":[{"name":"Medicine, Grampians Health, Ballarat, Victoria, Australia"},{"name":"The University of Melbourne, Melbourne Medical School, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"key":"2026072406101286000_19.7.e272147.1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.11761116"},{"key":"2026072406101286000_19.7.e272147.2","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2016070776"},{"key":"2026072406101286000_19.7.e272147.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0810457"},{"key":"2026072406101286000_19.7.e272147.4","doi-asserted-by":"crossref","DOI":"10.1038\/srep08803","article-title":"Diagnostic accuracy of PLA2R autoantibodies and glomerular staining for the differentiation of idiopathic and secondary membranous nephropathy: an updated meta-analysis","volume":"5","author":"Dai","year":"2015","journal-title":"Sci 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treatment for idiopathic membranous glomerulonephritis in pregnancy","volume":"13","author":"Irish","year":"2020","journal-title":"Obstet Med"},{"key":"2026072406101286000_19.7.e272147.10","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1007\/s13730-018-0304-7","article-title":"Membranous nephropathy associated with pregnancy: an anti-phospholipase A2 receptor antibody-positive case report","volume":"7","author":"Uchino","year":"2018","journal-title":"CEN Case Rep"},{"key":"2026072406101286000_19.7.e272147.11","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2010-07-295444"},{"key":"2026072406101286000_19.7.e272147.12","doi-asserted-by":"crossref","DOI":"10.1155\/2008\/271363","article-title":"Rituximab administration in third trimester of pregnancy suppresses neonatal B-cell development","volume":"2008","author":"Klink","year":"2008","journal-title":"Clin Dev 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