Kidney Week

Abstract: FR-PO0717

When Nephrotic Syndrome Turns Chylous: Phospholipase A2 Receptor Antibody-Positive Membranous Nephropathy with Renal Vein Thrombosis

Session Information

• Glomerular Diseases: Membranous Nephropathy, FSGS, and Podocytopathies
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Mirza, Sabbir, HCA Florida Lawnwood Hospital, Fort Pierce, Florida, United States

Sabbir Mirza, DO

• Kanu, Donald Orji, HCA Florida Lawnwood Hospital, Fort Pierce, Florida, United States

Donald Orji Kanu, MD, DO

• Isidor, Marc H., HCA Florida Lawnwood Hospital, Fort Pierce, Florida, United States

Marc H. Isidor, MD

• Khan, Rahil, HCA Florida Lawnwood Hospital, Fort Pierce, Florida, United States

Rahil Khan, MD

• Jensen, Zachariah, HCA Florida Lawnwood Hospital, Fort Pierce, Florida, United States

Zachariah Jensen, MD

• Razuman, Samerah Guro, HCA Florida Lawnwood Hospital, Fort Pierce, Florida, United States

Samerah Guro Razuman, MD

Group or Team Name

• Team Lawnwood

Introduction

Primary membranous nephropathy (MN) is a leading cause of adult nephrotic syndrome and is associated with phospholipase A2 receptor (PLA2R) autoantibodies in approximately 70–80% of primary cases. However, PLA2R-positive MN is less well characterized in African American patients, in whom secondary etiologies, APOL1-associated disease, and more aggressive phenotypes are often emphasized. Reports of biopsy-confirmed PLA2R-positive MN in this population remain limited, and atypical complications such as thrombosis are infrequently described.

Case Description

A 64-year-old African American male with hypertension presented with abdominal pain, hematochezia, and chronic lower extremity edema. Evaluation revealed nephrotic syndrome with significant proteinuria, hypoalbuminemia, hyperlipidemia, and elevated creatinine. Imaging demonstrated bilateral renal vein thrombosis and ascites; paracentesis confirmed chylous ascites. Serum anti-PLA2R antibodies were positive. Kidney biopsy showed 26 glomeruli with diffuse basement membrane “spikes,” mild mesangial expansion, focal segmental sclerosis, and mild interstitial fibrosis/tubular atrophy (~10%). Immunofluorescence demonstrated granular capillary loop staining for IgG (3+), C3 (2+), and light chains. Immunohistochemistry showed strong PLA2R positivity with negative NELL1, EXT2, and THSD7A. Electron microscopy revealed subepithelial and intramembranous deposits with diffuse podocyte foot process effacement, confirming primary PLA2R-associated MN. The patient was treated with anticoagulation and rituximab with clinical improvement.

Discussion

This case highlights a rare presentation of PLA2R-positive MN in an African American patient complicated by bilateral renal vein thrombosis and chylous ascites. Nephrotic syndrome–associated hypercoagulability likely contributed to thrombosis, with secondary lymphatic obstruction leading to chylous ascites. While thrombotic complications are recognized in MN, chylous ascites is uncommon. This case underscores the importance of recognizing atypical abdominal presentations in nephrotic patients and supports early evaluation for renal vein thrombosis. Antigen-specific diagnosis combined with timely anticoagulation and immunosuppressive therapy may improve outcomes.

Acknowledgment

This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.