Abstract: FR-PO0723
NELL-1-Positive Membranous Nephropathy in a Patient with Hematologic Malignancy Without Graft-vs.-Host Disease
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
- Selvam, Sri Abirami, Oregon Health & Science University, Portland, Oregon, United States
- Roberts, Samuel, Oregon Health & Science University, Portland, Oregon, United States
- Avasare, Rupali S., Oregon Health & Science University, Portland, Oregon, United States
- Padgett, Oliver, Oregon Health & Science University, Portland, Oregon, United States
Introduction
Neural epidermal growth factor-like 1 protein (NELL1) positive membranous nephropathy (MN) is a recently characterized subtype of MN with known associations including solid organ malignancy, hematopoietic stem cell transplantation, alpha-lipoic acid, NSAID use, and mercury exposure. Its association with hematologic malignancies outside the setting of graft versus host disease (GVHD) has not been described in literature
Case Description
An 80-year-old man with acute myeloid leukemia (AML), hypertension, prior stroke and a 40-pack-year smoking history was referred for persistent nephrotic-range proteinuria. At the time of initial AML diagnosis, he had a new 3+ dipstick proteinuria. He was admitted for induction chemotherapy with azacitidine, venetoclax and midostaurin; over the course of induction proteinuria worsened to peak urine protein to creatinine ratio (UPCR) 17.8 gram/gram creatinine (g/gCr) without acute kidney injury with improvement to 13.7g/gCr at time of hospital discharge. Medications were atorvastatin, clopidogrel, lisinopril, and tamsulosin. No over the counter medicine or supplement use reported. Serologic workup was negative, including anti-phospholipase A2 receptor antibody, ANA, complements, hepatitis, HIV and monoclonal protein evaluation. AML-associated pancytopenia precluded renal biopsy at that time. Morphologic remission was declared from bone marrow biopsy one month after induction. Eighteen months later, persistent nephrotic proteinuria despite AML remission prompted renal biopsy which demonstrated NELL-1 positive MN, mild tubulointerstitial inflammation, moderate arterial and arteriolar nephrosclerosis, 33% glomerular sclerosis, and 40% tubulointerstitial scarring. The patient was managed conservatively with renin-angiotensin system blockade and continuation of AML-directed therapy. Proteinuria subsequently improved to 2g/gCr on UPCR about 2 years after initiation of AML therapy
Discussion
The marked improvement in proteinuria temporally correlating with sustained hematologic remission, in the absence of immunosuppressive therapy for MN and without an identifiable alternative secondary cause suggests a potential causal relationship between AML and NELL1-positive MN. This case expands the spectrum of malignancy-associated NELL1 MN beyond solid organ tumors. Further studies are needed to characterize the relationship between hematologic malignancies and NELL1-positive MN