An Unlikely Culprit: A Case of Membranous Nephropathy with Celiac Disease
- Glomerular Diseases: Case Reports
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Trials
- Vaddadi, Sneha Madhuri, UC Davis Health, Sacramento, California, United States
- Wick, Katherine D., UC Davis Health, Sacramento, California, United States
- Jen, Kuang-Yu, UC Davis Health, Sacramento, California, United States
- Madan, Niti, UC Davis Health, Sacramento, California, United States
Membranous nephropathy is a cause of nephrotic syndrome, categorized as primary (e.g. anti-PLA2R-associated) or secondary (due to autoimmune conditions, malignancy). There are a few case reports demonstrating an association between membranous nephropathy and celiac disease, an autoimmune disorder affecting the small intestine with the ingestion of gluten, however, this association has not been well established. We present a case of secondary membranous nephropathy with celiac disease and subsequent complete remission with the treatment of the underlying disease.
A 46-year-old female initially presented for evaluation of the nephrotic syndrome with a urine protein to creatinine ratio 8.6 g/g and serum albumin of 1.8 g/dL. Workup for viral, autoimmune and malignant etiology significant only for evidence of prior Hepatitis B infection and positive surface antibodies. A kidney biopsy demonstrated evidence of early-stage membranous nephropathy without secondary features. Tissue PLA2R staining and Anti-PLA2 antibody testing were negative. The patient was diagnosed with primary membranous nephropathy due to negative secondary workup. Cyclosporine and low-dose prednisone treatment for 1 year resulted in partial remission. The patient then got diagnosed with Celiac Disease. She transitioned to a gluten-free diet with continued conservative management with an angiotensin-converting enzyme (ACE) inhibitor resulting in complete remission of her disease.
Celiac disease has been associated with IgA nephropathy; its presentation with IgG membranous nephropathy is not well-established. With an otherwise negative workup and despite biopsy results without secondary features, the etiology of the glomerular disease in this case was likely celiac disease given the complete remission only after dietary modification. This case demonstrates a potential novel association between the autoimmune condition celiac disease and secondary membranous nephropathy.
Figure 1: A. Immunofluorescence demonstrating IgG deposition along capillary loops
B. Subepithelial immune deposits on electron microscopy