{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T01:56:53Z","timestamp":1788400613724,"version":"build-2803163510"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T00:00:00Z","timestamp":1774224000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The M-type phospholipase A2 receptor (PLA2R) antibody positivity is considered a specific serological marker for idiopathic membranous nephropathy (IMN), and its presence in class V lupus nephritis (LN) is rare. There is limited reporting on the longitudinal progression from IMN to systemic lupus erythematosus (SLE) with class V LN, particularly in cases with persistently positive anti-PLA2R antibodies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 54-year-old woman presented with nephrotic syndrome in 2016, with initial renal biopsy showing podocyte disease. In 2020, disease recurrence with positive serum anti-PLA2R antibodies led to a second biopsy diagnosing IMN stage II. In 2024, she presented with edema and facial erythema. Serology revealed new-onset positive ANA and anti-dsDNA antibodies alongside persistent anti-PLA2R positivity, meeting SLE criteria. A third renal biopsy confirmed class V LN. After treatment with methylprednisolone and hydroxychloroquine, and following a rituximab infusion reaction, she achieved clinical remission with obinutuzumab.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights that positive anti-PLA2R antibodies do not definitively exclude secondary MN such as class V LN. Long-term serological monitoring and repeat renal biopsy should be considered in IMN patients with atypical clinical evolution to identify potential transformation to LN.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1801837","type":"journal-article","created":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T05:21:07Z","timestamp":1774243267000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Evolution of idiopathic membranous nephropathy to class v lupus nephritis: a case report and literature review"],"prefix":"10.3389","volume":"13","author":[{"given":"Bo","family":"Shen","sequence":"first","affiliation":[{"name":"Department of Blood Purification Center, Shaoxing Second Hospital","place":["Shaoxing, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Shaoxing 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