Kidney Week

Abstract: FR-PO0695

From Alopecia to Antigen: Mass Spectrometry Reveals Neuron-Derived Neurotrophic Factor-Positive Membranous Nephropathy

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

• Patel, Beyla, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States

Beyla Patel, MD, MPH

• Hignett, Emma, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States

Emma Hignett, MD

• Alexander, Mariam P., Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States

Mariam P. Alexander, MD

• Sethi, Sanjeev, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States

Sanjeev Sethi, MD, PhD

• Falk, Ronald, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States

Ronald Falk, MD, FASN

• Wyatt, Nicole Elizabeth, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States

Nicole Elizabeth Wyatt, DO

Introduction

Syphilis, caused by Treponema pallidum, classically presents with skin lesions, lymphadenopathy, and hepatosplenomegaly. Rarely, syphilis-associated membranous nephropathy (MN) may mimic autoimmune glomerular disease, ultimately delaying accurate diagnosis and appropriate treatment. We present a case of nephrotic syndrome with diffuse alopecia and edema ultimately attributed to syphilis.

Case Description

A 32-year-old female with a history of depression presented with one month of progressive bilateral lower extremity edema, 15-pound weight gain, and polyarthralgias following a recent gastrointestinal illness. She also reported diffuse hair loss from her scalp, eyebrows, and eyelashes. Initial lab work showed serum albumin 1.6 g/dL, urine sediment with 10 monomorphic rbc/hpf and hyaline casts, urine protein creatinine ratio 4.0 grams, and creatinine 0.68 mg/dL (baseline). Secondary workup was notable for positive ANA (1:320) with low C4 (1.4 mg/dL) plus normal C3 and negative anti-dsDNA, ENA, anti-PLA2R antibody, Rheumatoid Factor, hepatitis serologies, and HIV. Dermatologic evaluation revealed diffuse non-scarring alopecia thought to reflect an autoimmune etiology (Figure 1A). Renal biopsy demonstrated findings concerning for membranous pattern on light microscopy, full house staining on immunofluorescence, and extensive subepithelial deposits on electron microscopy. PLA2R staining was negative.

The patient was initially treated with prednisone (1mg/kg) due to concern for autoimmune disease, however further infectious workup revealed a markedly elevated RPR titer (>1:1024) with confirmatory TP-PA positive. Mass spectrometry was performed on the biopsy and confirmed Neuron-Derived Neurotrophic Factor (NDNF) positivity. Steroids were quickly tapered and she was treated with a 28-day course of doxycycline. She demonstrated rapid clinical improvement with resolution of edema, proteinuria, and RPR titers as well as progressive hair regrowth (Figure 1B).

Discussion

This case highlights syphilis as a rare but important cause of alopecia and MN, which is associated with NDNF as a target antigen. Techniques such as mass spectrometry enable detailed evaluation of target antigens in MN, helping differentiate etiologies and guide appropriate therapy particularly when systemic symptoms may lead to misdiagnosis and unnecessary immunosuppression.