Primary Membranous Nephropathy with Crescents

Abstract

ABSTRACT We present the case of a 46-year-old patient with a history of hypertension, renal biopsy-proven primary membranous nephropathy, and a unique progression. He initially presented with edema and hypertension. Even though he responded initially to immunosuppression, later the clinical picture worsened, prompting the need for a rebiopsy. A second renal biopsy revealed acute crescentic transformation superimposed on primary membranous glomerulonephritis. Immunohistochemistry confirmed Phospholipase A2 Receptor (PLA2R) staining positivity. Following pulse steroid therapy, the patient’s azotemia improved, and creatinine levels stabilized. This case highlights the rare occurrence of acute crescentic transformation in primary membranous nephropathy, emphasizing the challenges and complexities of management.