Abstract: FR-PO0696
The Great Imitator: Syphilis-Induced 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
- Sisel, Emily, Beth Israel Deaconess Hospital Department of Medicine, Boston, Massachusetts, United States
- Jaen, Giovana, Beth Israel Deaconess Hospital Department of Medicine, Boston, Massachusetts, United States
- Czarnecki, Peter G., Beth Israel Deaconess Hospital Department of Medicine, Boston, Massachusetts, United States
- Rosen, Seymour, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
Introduction
The incidence of syphilis in the US has increased 30-fold in 2023 compared to 2000. Recognizing renal manifestations of secondary syphilis is therefore critical.
Case Description
A 41-year-old man presented with a month of hematochezia and rectal pain. He reported being sexually active. Exam was notable for abdominal tenderness to palpation and no edema. Initial labs: BUN 29, Creatinine 2.2, Albumin 2.4, CRP 16. U/A had protein and blood (UPCR >5.3 g/g). Rapid Plasma Reagin (RPR) reacted at 1:128. CT Abdomen showed rectal thickening and inguinal lymphadenopathy with biopsies staining + for treponema antibody. Renal biopsy IF had granular staining pattern with IgG (2+), IgA (1-2+), C3 (1+), kappa LC (1+), lambda LC (1-2+), and C1q (1-2+). PLA2R staining was negative. EM had foot process effacement and subepithelial deposits, suggesting syphilis-associated membranous nephropathy (MN). He received Penicillin G and valsartan. By 4-month follow up, RPR titer decreased to 1:2, and Cr was 0.8, suggesting renal remission.
Discussion
Syphilis causes a spectrum of renal manifestations, including MN, RPGN, and AIN. Renal disease responds well to antibiotics alone. Renal complications of syphilis should be considered for patients with other features of secondary syphilis at presentation.
Jones Silver Stain
Immunofluorescence IgG Staining