Role of Anti-Phospholipase A(2) Receptor Antibodies in the Differential Diagnosis of Diabetic and Membranous Nephropathy

Diabetic nephropathy and membranous nephropathy can both present with nephrotic syndrome. Here, we report on a 43-year-old female patient suffering from type 1 diabetes, diabetic retinopathy, arterial hypertension, and nephrotic syndrome. Blood glucose levels were poorly controlled by a basal-bolus insulin regimen as shown by an HbA1c of 15.9% (150 mmol/mol). The concomitant antihypertensive medication consisted of an angiotensin-2 receptor blocker, a β-blocker, a calcium antagonist, and furosemide. In March 2012, her serum creatinine and urine albumin-to-creatinine ratio were 1.06 mg/dL and 7 g/g, respectively. Until December 2012, both serum creatinine and albuminuria increased to 1.9 mg/dL and 11 g/g urinary creatinine, respectively. The estimated glomerular filtration rate via the MDRD-2 formula (Modification of Diet in Renal Disease) declined from 56 to 28 mL/min/1.73 m2. Furthermore, she presented with aggravated leg oedemas, hypoalbuminemia of 2.4 mg/dL, hypertriglyceridemia, and hypertension reflecting nephrotic syndrome. …