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Abstract: SA-PO141

A Journey From Primary Membranous to Secondary Membranous Nephropathy

Session Information

Category: Onconephrology

  • 1600 Onconephrology

Authors

  • Khan, Rana Raheel Hafeez, The University of Texas Health Science Center at Houston, Houston, Texas, United States
  • Fareedy, Shoaib Bilal, The University of Texas Health Science Center at Houston, Houston, Texas, United States
  • Tchakarov, Amanda, The University of Texas Health Science Center at Houston, Houston, Texas, United States
  • Abudayyeh, Ala, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
Introduction

Membranous Nephropathy (MN) has been well recognized as a common cause of nephrotic syndrome as primary membranous (autoimmune induction) vs secondary membranous, with up to 20% related to cancers in older patients. We are presenting a case of recurrent proteinuria in a patient who had primary MN in remission that many years later develops secondary MN

Case Description

68 years old male with a history of chronic kidney disease, primary MN, diagnosed in the 1970s and off immunosuppression since 2016. He has a history of prostate cancer , treated melanoma in situ, hypertension, diabetes, with no proteinuria and creatinine at baseline of 1.4mg/dl.
On 2022 patient presented with 2.2gms of proteinuria with negative 2nd workup. He underwent a renal biopsy, showing MN, negative Phospholipase A2 receptors, 22% global sclerosis and 10% interstitial fibrosis. Imaging studies revealed a lung nodule with a biopsy confirming melanoma with adrenal and brain metastases. The patient was started Ipilimumab and nivolumab with significant tumor response but progression of proteinuria to over 15gms. He has also developed grade II colitis and was started on steroids and rituximab with improved proteinuria to 4g.

Discussion

It is well documented that, compared to the general population, patients with MN have a higher cancer incidence. This unique case demonstrates the evolution from primary MN to 2nd MN in the same patient which was an indicator of patients underlying malignancy. The patients advanced cancer necessitated emergent treatment in hopes of response of MN in setting of cancer response. Unfortunately, the overwhelming immune activation further impacted the MN and rituximab was successful to attain renal response and continue patient on Immunotherapy. This case demonstrates much more needed research in this field of autoimmune disease in a cancer patient and the use of ICI which is an unmet need.