Hepatic Glomerulopathy After Liver Transplant: An Unexplored Clinical Entity
- Glomerular Diseases: From Inflammation to Fibrosis - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1401 Glomerular Diseases: From Inflammation to Fibrosis
- Zghayer, Aseel, Loyola University Health System, Maywood, Illinois, United States
- Borys, Ewa, Loyola University Health System, Maywood, Illinois, United States
- Picken, Maria M., Loyola University Health System, Maywood, Illinois, United States
- Vellanki, Kavitha, Loyola University Health System, Maywood, Illinois, United States
Hepatic glomerulopathy, also known as hepatic glomerulosclerosis is a secondary glomerular process that occurs in the context of liver failure and cirrhosis. Pathogenesis involves acquired LCAT (Lecithin–Cholesterol Acyltransferase) deficiency as the enzyme is mainly synthesized in the liver. Deposition of lipid particles in glomerular basement membrane (GBM) similar to those seen in congenital LCAT deficiency is pathognomonic. Here, we present a unique case of persistent hepatic glomerulopathy post liver transplant.
A 58-year-old man s/p liver transplant with prior h/o alcoholic cirrhosis complicated by hepatocellular carcinoma presented to nephrology clinic for evaluation of persistent proteinuria post liver transplant. His immunosuppression includes tacrolimus and mycophenolate and BP is well controlled. Work up revealed nephrotic range proteinuria (approx. 4 gm/gm creatinine), rest is shown in Table 1. Kidney biopsy revealed deposition of lipid particles in glomerular basement membrane and metastatic micro-calcifications (Image 1).
Hepatic glomerulopathy is an unexplored clinical entity which is characterized by deposition of small, irregular partially electro-lucent lipid particles in the subepithelial, intramembranous, subendothelial and mesangial regions as seen in our patient. The prevalence of hepatic glomerulopathy in liver disease is not known, nor is the clinical course post liver transplantation. To our knowledge, our case is the first to be reported in literature of persistent findings post liver transplantation. We believe raising awareness of the disease entity will help in understanding the clinical course and exploring treatment options.