Abstract: TH-PO0800
Rare Overlap of Recurrent Phospholipase A2 Receptor (PLA2R)-Positive Membranous Nephropathy (MN) with Concomitant Tubulointerstitial Nephritis and Uveitis (TINU): A Case Report
Session Information
- Glomerular Case Reports: Membranous, PGN, GBM, and More
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Persaud, Steven H., USF Nephrology Fellowship, Tampa, Florida, United States
- Patel, Aditya NitinKumar, USF Observer, Tampa, Florida, United States
- Malhotra, Ruchika, USF Nephrology Fellowship, Tampa, Florida, United States
- Bassil, Claude, USF Nephrology Fellowship, Tampa, Florida, United States
- P Narayanankutty, Naveen, USF Nephrology Fellowship, Tampa, Florida, United States
Introduction
TINU syndrome is a rare oculorenal syndrome that uncommonly coexists with PLA2R-positive MN. This case highlights the rare overlap of these two conditions, posing a challenge to diagnosis and treatment.
Case Description
A 23-year-old man with a history of MN diagnosed in 2020, treated with mycophenolate mofetil and prednisone, which was in remission for a few years with <1g/day of proteinuria, presented with bilateral eye redness, pain, photophobia, and headaches. Unfortunately, there was a discontinuation of medications.
Lab evaluation showed nephrotic-range proteinuria 22g/24hr, microscopic hematuria, severe hypoalbuminemia 1.2 g/dl, anemia Hgb 7.0 g/dl, elevated creatinine 6.7 mg/dl, rare eosinophiluria, thrombocytosis, positive EBV IgG and normal IgG4. The ophthalmic exam confirmed anterior uveitis. A CT guided kidney biopsy revealed PLA2R-positive MN (EM stage 3) with superimposed mild chronic active tubulointerstitial nephritis, severe interstitial fibrosis 70%, and tubular atrophy. Immunofluorescence (IF) showed subepithelial and intramembranous, electron-dense, immune complex deposits. These features suggested recurrent MN with possible TINU syndrome. Topical and systemic corticosteroids were preferred for treatment, with a plan of likely needing hemodialysis in the future due to severe interstitial fibrosis and limited use of DMARDs (disease-modifying anti-rheumatic drugs) or immunosuppressants.
Discussion
This case highlights the fact that recurrent MN can present with TINU syndrome as a clinical picture. Ophthalmologic evaluation could worthy in MN to prevent progression to TINU, if any.