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Internal Medicine

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Clinical Science

Abstract

Introduction 10% of membranous nephropathy (MN) cases are linked to solid organ tumors, most commonly in Caucasians. Positive anti phospholipase-A2-receptor (PLA2R) autoantibodies are found in 75% of patients with primary MN but are rare in secondary MN such as from solid tumors. We present a case that is unique due to Hispanic ethnicity and antibody positivity in a secondary MN.

Case report A 57-year-old Hispanic woman with a history of HER-2 negative, grade 2 invasive lobular breast cancer presented to the office with lower extremity edema. She was found to have Nephrotic Range proteinuria (28 grams) with normal Creatinine and was referred to Nephrology. Kidney biopsy exhibited enlarged glomeruli and diffuse, thick, rigid looking capillary loops with intermittent mottling on silver stain under light microscopy. Segmental sclerosis was observed in one glomerulus. Immunohistochemical staining for the PLA2R performed, indicated diffuse Positive staining along the glomerular basement membranes. Glomeruli immunohistochemistry revealed diffuse and global granular capillary loop staining for IgG (3+), C3 (2+ and 3+), and lambda (3+) light chains.

The patient was admitted for intravenous methylprednisolone and Rituximab for Immunosuppression as the she had a component of Primary MN with positive PLA2R antibodies.

Conclusion Membranous nephropathy (MN) is commonly seen in Caucasian population but is unusual among the Hispanic population. The uniqueness of this case is increased by the existence of secondary MN in a Breast cancer Hispanic patient with positive PLA2R antibodies, which changes management.

Treatment of Secondary MN is to address the underlying cause, which in this case is breast cancer. This patient has secondary MN with positive PLA2R antibodies. So, the treatment is to add immunosuppression. After a kidney biopsy confirms the presence of PLA2R antibodies, patients should be started on immunosuppressive induction therapy with intravenous steroids and rituximab, with serial measures of creatinine, 24-hour proteinuria, and anti-PLA2R antibody titers to determine remission.

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Hispanic Patient with Breast Cancer and Secondary Membranous Nephropathy with rare positive anti-PLA2R autoantibodies which changes the management.

Introduction 10% of membranous nephropathy (MN) cases are linked to solid organ tumors, most commonly in Caucasians. Positive anti phospholipase-A2-receptor (PLA2R) autoantibodies are found in 75% of patients with primary MN but are rare in secondary MN such as from solid tumors. We present a case that is unique due to Hispanic ethnicity and antibody positivity in a secondary MN.

Case report A 57-year-old Hispanic woman with a history of HER-2 negative, grade 2 invasive lobular breast cancer presented to the office with lower extremity edema. She was found to have Nephrotic Range proteinuria (28 grams) with normal Creatinine and was referred to Nephrology. Kidney biopsy exhibited enlarged glomeruli and diffuse, thick, rigid looking capillary loops with intermittent mottling on silver stain under light microscopy. Segmental sclerosis was observed in one glomerulus. Immunohistochemical staining for the PLA2R performed, indicated diffuse Positive staining along the glomerular basement membranes. Glomeruli immunohistochemistry revealed diffuse and global granular capillary loop staining for IgG (3+), C3 (2+ and 3+), and lambda (3+) light chains.

The patient was admitted for intravenous methylprednisolone and Rituximab for Immunosuppression as the she had a component of Primary MN with positive PLA2R antibodies.

Conclusion Membranous nephropathy (MN) is commonly seen in Caucasian population but is unusual among the Hispanic population. The uniqueness of this case is increased by the existence of secondary MN in a Breast cancer Hispanic patient with positive PLA2R antibodies, which changes management.

Treatment of Secondary MN is to address the underlying cause, which in this case is breast cancer. This patient has secondary MN with positive PLA2R antibodies. So, the treatment is to add immunosuppression. After a kidney biopsy confirms the presence of PLA2R antibodies, patients should be started on immunosuppressive induction therapy with intravenous steroids and rituximab, with serial measures of creatinine, 24-hour proteinuria, and anti-PLA2R antibody titers to determine remission.

 

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