Spontaneous Remission of Late Relapsing Membranous Nephropathy After Previous Immunosuppressant-Induced Remission: Case Report
Abstract
This is the first detailed report of spontaneous remission of late relapsing membranous nephropathy (MN) after previous immunosuppressant-induced remission. In March 2004, a 52-year-old Hispanic male presented with severe nephrotic syndrome with proteinuria of 13 g/24 h. The workup for infectious and autoimmune diseases was unrevealing. Renal biopsy showed MN (Stage II). A CT scan showed no malignancy but left pulmonary embolism and left renal vein thrombosis. Anticoagulation was started for asymptomatic thromboembolism. He achieved sustained complete remission of nephrotic syndrome after a prolonged, complicated treatment course of multiple immunosuppressants (corticosteroids and mycophenolate mofetil for 1 year, followed by alternating monthly corticosteroids and chlorambucil for 6 months, and again corticosteroids and mycophenolate mofetil for 6 years). Then in July 2021 (now at the age of 69 years), he developed nephrotic syndrome again with proteinuria of 6 g/24 h. Serological work-up was all negative except for the elevated serum Antiphospholipase A2 receptor (PLA2R) antibody at 42 RU/mL (nl < 14). Renal biopsy in November 2021 showed again MN (Stage III to IV). Immunohistochemistry staining of the biopsy tissue for PLA2R1 antigen was positive. A decision was made to observe him instead of starting immunosuppressants. He was treated with diuretics and Lisinopril. Anti-PLA2R antibody steadily improved to normal range and the nephrotic syndrome gradually improved and…
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