Abstract: TH-PO0787
Not Your Typical Membranous Nephropathy
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
- Ashoka, Ankita, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Patel, Krunal, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Moreno, Vanessa, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Chen, Dhruti P., The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
Introduction
“Full-house” (FH) immunofluorescence (IF) staining pattern on kidney biopsy is synonymous with lupus nephritis. However, rare cases with a similar pattern have been reported in non-lupus glomerulonephritides, including membranous nephropathy (MN). We report a case of MN with dual positivity for PLA2R and NELL1, along with a FH staining pattern on kidney biopsy.
Case Description
50-year-old male presented for evaluation of proteinuria (Fig 1.). No over the counter medications or illegal drug use noted. Blood pressure was 167/94 mmHg. Lab work showed serum creatinine 2.47 mg/dL (baseline ~1.6 mg/dL), Albumin 1.8 mg/dL, urine protein to creatinine (UPCR) 16,976 mg/g, urine albumin to creatinine 8,431 mg/g. Anti-PLA2R was markedly elevated at 532 RU/ml, complement level (C3 and C4) was normal. Syphilis, HIV, hepatitis B and C, anti-nuclear antibody, extranuclear antibody, anti-double stranded DNA, monoclonal gammopathy, cancer screening were negative. Kidney biopsy (Fig 2.) revealed MN stage III – IV, with +PLA2R, +NELL-1, and FH IF staining pattern. Patient was treated as primary MN and initiated on Mycophenolic Acid (MPA) given proliferative changes on biopsy, while pending Rituximab infusions.
Discussion
Dual positivity for NELL1 and PLA2R, along with FH IF pattern in MN has not been previously reported. NELL1 has been linked to secondary MN. Non-Lupus FH staining pattern has been suggested as a early indicator of systemic lupus erythematosus.The presence of overlapping features on kidney biopsy in MN may warrant close clinical monitoring for emerging secondary causes of MN.