Primary antiphospholipid syndrome associated with anti-phospholipase A2 receptor antibody-positive membranous nephropathy

Autor: Sophie Renaud, Pascal Reboul, Hélène Perrochia, Maxime Teisseyre, Cedric Aglae, Olivier Moranne, S. Cariou
Přispěvatelé: Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Université de Montpellier (UM), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)
Rok vydání: 2020
Předmět:
Male
Nephrology
Membranous nephropathy
medicine.medical_specialty
Nephrotic syndrome
030232 urology & nephrology
Case Report
030204 cardiovascular system & hematology
lcsh:RC870-923
Glomerulonephritis
Membranous
[SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology
Gastroenterology
Nephropathy
03 medical and health sciences
Glomerulonephritis
0302 clinical medicine
immune system diseases
Antiphospholipid syndrome
Internal medicine
medicine
Humans
skin and connective tissue diseases
PLA2R antibody
Lupus anticoagulant
MESH: Antiphospholipid Syndrome / complications
MESH: Humans
MESH: Middle Aged
MESH: Glomerulonephritis
Membranous / immunology
business.industry
Receptors
Phospholipase A2
MESH: Glomerulonephritis
Membranous / blood
MESH: Antibodies
Antiphospholipid / blood
Middle Aged
lcsh:Diseases of the genitourinary system. Urology
medicine.disease
MESH: Male
3. Good health
Antibodies
Antiphospholipid
MESH: Glomerulonephritis
Membranous / pathology
MESH: Receptors
Phospholipase A2 / immunology
Rituximab
business
MESH: Antiphospholipid Syndrome / blood
medicine.drug
Zdroj: BMC Nephrology
BMC Nephrology, BioMed Central, 2020, 21, pp.196. ⟨10.1186/s12882-020-01856-z⟩
BMC Nephrology, Vol 21, Iss 1, Pp 1-3 (2020)
ISSN: 1471-2369
DOI: 10.1186/s12882-020-01856-z
Popis: Background The kidney is a major target in primary antiphospholipid syndrome. Several types of nephropathy have been reported, the most frequent being acute or chronic specific vascular nephropathies and membranous nephropathy. Case presentation A 59-year-old male presented in our unit with nephrotic syndrome. He had a history of primary antiphospholipid syndrome with lupus anticoagulant treated with vitamin K antagonist therapy. On admission, antiphospholipid (lupus anticoagulant) and anti-PLA2R antibodies were positive. Screening for secondary etiologies was negative. In the context of primary antiphospholipid syndrome treated with vitamin K antagonist therapy, we did not perform a biopsy and we treated the patient with angiotensin-converting-enzyme inhibitor. No remission was observed at 6 months with persistent anti-PLA2R antibodies while antiphospholipid antibody level became negative. Consequently, kidney biopsy was performed showing both membranous nephropathy with PLA2R in deposits on immunohistochemistry with IgG4 dominance and antiphospholipid syndrome chronic vascular nephropathy. Following that, treatment with rituximab was started with secondarily a decrease in serum PLA2R antibody levels and partial remission. Conclusion We report the first association between primary antiphospholipid syndrome and membranous nephropathy with anti-PLA2R antibodies. Our observations could suggest a causal link between primary antiphospholipid syndrome and PLA2R-related membranous nephropathy. Consequently, it would be interesting to screen for anti-PLA2R antibodies for further cases of nephrotic syndrome in patients with primary antiphospholipid syndrome and to search antiphospholipid antibodies in all membranous nephropathies.
Databáze: OpenAIRE
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