Abstract: SA-PO0740
Rheumatoid Arthritis-Associated Membranoproliferative Glomerulonephritis Presenting as Nephrotic Syndrome and AKI
Session Information
- Glomerular Diseases: Complement-Mediated Glomerulopathies and Infection-Related GN
October 24, 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
- Nunes, Marta, UT Health East Texas, Tyler, Texas, United States
- Weyer, Alyssa Caparas, UT Health East Texas, Tyler, Texas, United States
- Greenwell, Mark W., UT Health East Texas, Tyler, Texas, United States
Introduction
Membranoproliferative glomerulonephritis (MPGN) is an immune-mediated pattern of glomerular injury associated with autoimmune disease, chronic infections, and monoclonal gammopathies. Renal manifestations of rheumatoid arthritis (RA) are uncommon in the modern treatment era, and RA-associated immune complex MPGN remains rare.
Case Description
A 67-year-old woman with RA, hypertension, COPD, hypothyroidism, and chronic kidney disease stage 3a (baseline creatinine 1.1–1.3 mg/dL) presented with progressive lower extremity edema, worsening hypertension, dysuria, and flank pain. She had recently completed trimethoprim-sulfamethoxazole therapy for presumed recurrent urinary tract infections despite negative cultures. Laboratory evaluation demonstrated acute kidney injury with creatinine increasing to 2.5 mg/dL, nephrotic-range proteinuria (10 g/day), hypoalbuminemia, and dysmorphic hematuria. Urinalysis showed 4+ protein and 3+ blood with >50 red blood cells per high-power field.
Serologic evaluation revealed low-normal complement levels with negative ANA, anti-dsDNA, anti-GBM, PLA2R antibody, hepatitis B and C serologies, and HIV testing. Kidney biopsy demonstrated immune complex–mediated MPGN.
The patient was treated with intravenous methylprednisolone followed by oral prednisone, resulting in improvement of kidney function back to baseline. However, patient could not tolerate prednisone. Mycophenolate mofetil was initiated as a steroid sparing therapy for immune-mediated disease management with continued recovery of kidney function.
Discussion
This case highlights an uncommon presentation of RA-associated immune complex MPGN presenting with nephrotic range proteinuria, hematuria, and acute kidney injury. The differential diagnosis included infection-related glomerulonephritis, drug-induced nephropathy, ANCA-associated vasculitis, lupus nephritis, and cryoglobulinemic disease. Kidney biopsy was critical for diagnosis and treatment selection. Early recognition and prompt immunosuppressive therapy resulted in significant renal recovery.