Abstract: TH-PO0802
Necrotizing Crescentic Membranous Nephropathy in a Patient with a Vaping Addiction
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
- Eyasu, Nahom, Emory University School of Medicine, Atlanta, Georgia, United States
- Abraham, Mona, Emory University School of Medicine, Atlanta, Georgia, United States
- Gammada, Leilani E., Tulane University School of Medicine, New Orleans, Louisiana, United States
- Farris, Alton Brad, Emory University School of Medicine, Atlanta, Georgia, United States
- Cobb, Jason, Emory University School of Medicine, Atlanta, Georgia, United States
Introduction
Membranous nephropathy (MN) is a leading cause of nephrotic syndrome in adults and typically follows a slow progression. Rarely, MN can present with rapidly progressive glomerulonephritis (RPGN) marked by necrosis and crescents. These aggressive features are most often associated with positive autoimmune serologies such as ANCA, anti-GBM, or ANA. Necrotizing crescentic glomerulonephritis (GN) is more commonly observed in drug-induced ANCA-associated vasculitis or lupus nephritis but has also been reported in MN linked to drug exposure. E-cigarette use (vaping) is increasingly common, particularly among young adults. Though marketed as safer than cigarettes, emerging evidence indicates a risk of multi-organ toxicity, including renal injury.
Case Description
A 37-year-old man with hypertension and daily e-cigarette use presented with fluid overload and acute kidney injury. Labs showed serum creatinine 3.2 mg/dL, urine protein-to-creatinine ratio 9.2 g/g, and albuminuria 4.9 g/g. Urinalysis revealed microscopic hematuria. Empiric pulse-dose corticosteroids were initiated. Extensive serologic workup—including hepatitis B and C, HIV, ANA, ANCA, C3, C4, cryoglobulins, and anti-PLA2R antibodies—was negative. He denied NSAIDs, herbal remedies, or illicit drugs; urine drug screen was negative.
Despite treatment, creatinine rose to 7.09 mg/dL, and intermittent hemodialysis was started. Kidney biopsy revealed IgG-dominant MN with focal endocapillary proliferation, necrosis, and crescent formation. Additional findings included diffuse acute tubular injury, 60% interstitial fibrosis and tubular atrophy (IFTA), and FSGS in 4 of 101 glomeruli. Cyclophosphamide was initiated but the patient was non-adherent. He remains dialysis-dependent and continues to vape daily.
Discussion
This is a rare case of necrotizing crescentic MN in a seronegative patient with a vaping addiction. Secondary causes were ruled out, including autoimmune, infectious, and toxic exposures. Given the degree of acute tubular injury and severe histologic features, we concluded that chronic e-cigarette use was the likely inciting factor. With the increasing prevalence of vaping, clinicians should be aware of its potential to cause serious renal injury, in addition to its better-known pulmonary and cardiovascular effects.