Abstract: FR-PO0817
Mercury-Associated NELL-1 Membranous Nephropathy: A Case Report and Systematic Review
Session Information
- Glomerular Diseases: Practice and New Concepts Shaping Modern Care
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
- Chakravarty, Bishan, Avera Health, Sioux Falls, South Dakota, United States
- Yu, Bo, Avera Health, Sioux Falls, South Dakota, United States
- Rastogi, Prerna, University of Iowa Health Care, Iowa City, Iowa, United States
Background
Mercury exposure from skin-lightening cosmetics and traditional medicines is an increasingly recognized cause of secondary glomerular disease. Neural epidermal growth factor-like 1 (NELL1) has emerged as a target antigen in mercury-associated membranous nephropathy (MN), but pooled clinical data remain limited.
Methods
We report a case of biopsy-proven NELL1-positive MN associated with mercury-containing skin-lightening cream and performed a systematic review of published mercury-associated glomerular disease cases (PubMed, Embase, and Web of Science through March 2026).
Results
A 29-year-old woman presented with nephrotic syndrome (UPCR 7.5 g/g) after prolonged use of imported skin-lightening cream containing 23,000 ppm mercury (FDA limit ≤1 ppm). Kidney biopsy demonstrated NELL1-positive MN with negative PLA2R testing. Following exposure cessation alone, UPCR improved by 94% to 0.48 g/g within 3 months, with resolution of edema and normalization of serum albumin.
Across pooled published cases, MN was the predominant histologic subtype, with most patients demonstrating PLA2R-negative disease and NELL1 positivity. Cosmetic exposure accounted for approximately half of identified cases, while traditional medicines represented another major exposure source. Exposure cessation alone achieved remission in the majority of patients, whereas progression to CKD/ESRD was rare. Relapses were primarily associated with recurrent exposure.
Conclusion
Mercury-associated glomerular disease is an underrecognized but potentially reversible secondary nephropathy characterized by PLA2R-negative, NELL1-predominant MN. Targeted environmental and cosmetic exposure history is essential in patients presenting with MN and nephrotic syndrome, as early identification and exposure cessation are associated with favorable renal outcomes.