Cases Of Membranous Nephropathy Research Articles

Resolution of Membranous Glomerulopathy after pregnancy: An interesting case report.

Proteinuria before twenty weeks of gestation should always be evaluated as it can be due to underlying glomerular diseases. We present a case of membranous nephropathy during pregnancy diagnosed by kidney biopsy and negative PLA2r aantibodies. Therapy was initiated with prednisolone 60mg per day. Calcineurin Inhibitor was also later started. Termination of Pregnancy when worsening of proteinuria was observed on followup. Patient achieved partial remission after two weeks and complete remission after one and half month of termination of pregnancy.

De novo and recurrent post-transplant membranous nephropathy cases show similar rates of concurrent antibody-mediated rejection.

Membranous nephropathy (MN) can develop post-kidney transplant and is classified as a recurrent disease in patients with a history of MN in the native kidneys or as de novo disease in patients without such history. The mechanism of recurrent MN is thought to be like that of primary MN, but the mechanism of de novo MN is not well delineated. An association between de novo MN and antibody-mediated rejection (AMR) has been suggested. A search of the pathology database from our medical center identified 11 cases of recurrent and 15 cases of de novo MN, in which clinical and histologic findings were compared. No significant differences were identified in the demographic characteristics, serum creatinine and proteinuria trends, or rates of allograft failure between the recurrent and de novo MN groups. Rates of concurrent AMR were high in both groups (36% and 40%, respectively) but not statistically different from each other. PLA2R immunofluorescence (IF) positivity was seen in 64% of recurrent MN cases compared to 33% of de novo MN cases, suggesting a higher incidence of PLA2R-positive de novo MN than previously reported. No significant histologic differences were identified in the initial biopsies from the two groups, except mean IgG intensity by IF was higher in the recurrent group, suggesting a higher load of immune complex deposits at diagnosis in this group. The findings do not provide support for a specific association between AMR and de novo MN, but whether there is a possible link between both forms of post-transplant MN and AMR remains an unanswered question.

Prevalence of Anti-PLA2R Antibodies in Biopsy Proven Membranous Nephropathy in Egyptian Patients

Abstract Background Membranous nephropathy (MN) is among the most common causes of the nephrotic syndrome in nondiabetic adults, accounting for approximately 20 to 30 percent of cases of nephrotic syndrome in White adults. MN is most often primary (previously called idiopathic), although it may be secondary with hepatitis B infection, autoimmune diseases as systemic lupus erythematosus (SLE), malignancies, and the use of certain drugs such as nonsteroidal antiinflammatory drugs (NSAIDs). MN in young females should raise the suspicion of SLE. Aim of the Work The aim of this work was to study the prevalence of anti-PLA2R antibodies in Egyptian patients with biopsy proven membranous nephropathy. Patients and Methods Our cross-sectional study included 70 Egyptian patients with nephrotic range proteinuria on first presentation for whom laboratory investigations including serum anti- PLA2R antibodies titer by indirect immunoflouresence and kidney biopsy were done. Results Membranous nephropathy has been diagnosed in 35.71% of adult Egyptian patients presented with nephrotic range proteinuria. 84% of the cases of membranous nephropathy had been diagnosed with primary membranous nephropathy and 16% diagnosed with secondary membranous nephropathy. Sensitivity of circulating anti-PLA2R antibodies in primary MN was 42.85% versus 80.95% for its detection within the glomerular extracts. Specificity of PLA2R is close to 100%; however, in other studies; PLA2R has been detected in the immune deposits of some patients with secondary MN. Patients with high anti-PLA2R titer had higher baseline proteinuria than patients with lower anti-PLA2R titer. Conclusion Membranous nephropathy (primary and secondary) may be considered the most common glomerulonephritis by biopsy finding in patients presenting with nephrotic range proteinuria followed by focal segmental glomerulosclerosis (35.7 %& 30% respectively). 84% of the cases of membranous nephropathy had been diagnosed with primary membranous nephropathy and 16% had been diagnosed with secondary membranous nephropathy. Circulating anti-PLA2R antibodies were detected within serum in 42.85% of primary MN cases while detection of anti- PLA2R antibodies within the glomerular extracts of primary MN cases was much higher (80.95%). Specificity of PLA2R is close to 100%; however, in other studies; PLA2R has been detected in the immune deposits of some patients with secondary MN. Patients with high anti-PLA2R titer had higher baseline proteinuria than patients with lower anti-PLA2R titer.

A case of membranous nephropathy complicated by Cronkhite-Canada syndrome successfully treated with mizoribine.

Cronkhite-Canada syndrome (CCS) is a non-hereditary disorder characterized by non-neoplastic hamartomatous gastrointestinal polyposis, hair loss, nail atrophy, hyperpigmentation, and diarrhea. While the relationship between CCS and nephritis remains unclear, seven cases of nephritis complicated by CCS have been reported to date, all of which were membranous nephropathy (MN). A 57-year-old man presented with taste disturbance, hair loss, nail plate atrophy, skin pigmentation, and frequent diarrhea. Endoscopic findings showed multiple polyposis of the stomach and large intestine. Given the above, he was diagnosed with CCS. The symptoms gradually improved with prednisolone treatment, although urinary protein and hypoproteinemia appeared during the tapering of prednisolone. He was diagnosed with MN using a renal biopsy, and immunofluorescence microscopy with IgG subclass staining showed predominantly diffuse granular capillary wall staining of IgG4. The cause of secondary MN was not found, including malignant tumors. Nephrotic-range proteinuria persisted despite treatment with prednisolone and cyclosporine. Additional treatment with mizoribine resulted in incomplete remission type 1 of nephrotic syndrome, suggesting that mizoribine may be a treatment option for patients with CCS with steroid-resistant MN. Considering a high prevalence of hypoproteinemia due to chronic diarrhea and protein-losing enteropathy in patients with CCS, proteinuria might be overlooked; thus, follow-up urinalysis would be recommended in patients with CCS.

A Rare Case of Membranous Nephropathy Complicated by Chylothorax.

Chylothorax can be classified into traumatic and nontraumatic based on the etiology. Nephrotic syndrome is a very rare cause of nontraumatic chylothorax in adults. A 66-year-old woman with membranous nephropathy who was non-compliant with her management, presented with dyspnea, and was found to have a large right sided chylothorax. Her chylothorax was secondary to membranous nephropathy after excluding other causes, which has been rarely reported in literature. This case highlights the possibility of nephrotic syndrome causing chylothorax, especially in patients with undiagnosed nephrotic syndrome or patients non-compliant with their management. When evaluating a patient with chylothorax, providers should consider nephrotic syndrome in the differential diagnosis. Chylothorax can be secondary to nephrotic syndrome which has been rarely reported in literature.Providers should be aware of nephrotic syndrome as a cause of chylothorax especially in patients with undiagnosed nephrotic syndrome or non-compliance with their management.Treatment of underlying cause is usually sufficient for spontaneous resolution of chylothorax with or without pleural fluid evacuation.

#162 Single-nucleus RNA-seq of biopsy-confirmed IgA nephropathy reveals cell-specific transcriptomic alteration

Abstract Background and Aims Single-nucleus RNA-seq (SnRNA-seq) is a valuable method for identifying cell-specific transcriptomic alterations in kidney cells. Our objective was to investigate SnRNA-seq data from biopsy-confirmed IgA nephropathy (IgAN) cases and identify cell-specific alterations in the transcriptome. Method We collected snap-frozen kidney biopsy tissues from 6 cases of IgA nephropathy (IgAN) and 7 nephrectomy control cases. The disease control group included 3 cases of diabetic kidney disease, 6 cases of minimal change disease, and 6 PLA2R-Ab positive membranous nephropathy cases. SnRNA-seq was performed on the kidney tissues, and kidney cells were identified in the dataset through UMAP clustering. We investigated differences in the proportion of kidney cell types and identified differentially expressed genes (DEGs). Additionally, we searched for representative gene loci previously reported in a multiethnic genome-wide association study (GWAS). Results We successfully collected transcriptomic profiles of >50 000 cells from IgAN, with a considerable enrichment of intraglomerular cells. The DEG analysis revealed a high number of DEGs in mesangial cells, fibroblasts, and vascular smooth muscle cells in the IgAN transcriptome compared to the nephrectomy and disease control cases. In the gene set enrichment analysis, the epithelial-mesenchymal transition pathway was enriched in the glomerular cells of IgAN. Furthermore, among various GWAS loci, ETS1 was the gene significantly highly expressed in the mesangial cells of IgAN, consistent across the compared control groups. Conclusion This investigation represents the largest SnRNA-Seq profiling of IgAN kidney cells to date. We identified notable enriched cell-specific pathways in IgAN. ETS1 may be a kidney-indwelling causal factor for IgAN pathophysiology, considering its notable significance in both previous GWAS results and the current SnRNA-Seq data.

Recurrence of Glomerulonephritis After Kidney Transplantation - Experience of One Center from 2020 to 2023

Glomerulonephritis (GN) after kidney transplantation is a common problem. Many of them are recurrences of the primary disease in the transplanted kidney. The course and prognosis of individual types of glomerulonephritis (GN) are very different and their appearance may worsen the graft survival. World statistics show significant discrepancies regarding the incidence of GN recurrence depending on the adopted protocol (protocolar biopsy or due to symptoms). We analyzed the transplanted kidney biopsy results that are performed only in symptomatic patients. A group of 125 patients transplanted and treated in one medical center were observed. In this group, in 32 patients, the primary kidney disease was GN, confirmed by kidney biopsy before transplantation. Twenty three kidney biopsies were performed; in 8, cases the primary disease was GN. The indication for biopsy were hematuria and/or proteinuria and/or graft failure. We diagnosed 5 cases of GN, including 4 cases of GN recurrence (12.5% in whole GN group, 50% in symptomatic GN group). In the relapse group, there was 1 case of IgA nephropathy (the earliest recurrence 1 month after transplantation), 1 case of focal segmental glomerulosclerosis, 1 case of membranous nephropathy, and 1 case of lupus nephritis (the latest recurrence 1 year and 4 months after transplantation). Our observation showed a high percentage of GN recurrences in symptomatic patients. This indicates the need to specify data regarding the diagnosis of recurrence depending on the adopted research method (protocolar or due to symptoms biopsy) to know which patients should be treated.

388 An unusual case of membranous nephropathy in a patient with Kikuchi–Fujimoto disease

388 An unusual case of membranous nephropathy in a patient with Kikuchi–Fujimoto disease

Tubular basement membrane deposits after allogeneic hematopoietic stem cell transplantation

BackgroundExtraglomerular immune complex deposition is rare and only a few membranous nephropathy cases with tubular basement membrane deposits have been reported following allogeneic hematopoietic stem cell transplantation.Case presentationWe reported a 56-year-old man with increased serum creatinine after allogeneic hematopoietic stem cell transplantation who underwent a renal biopsy. Tubular interstitial nephritis was identified on light microscope. The unique histologic features were diffuse tubular basement membrane immune complex deposition detected by both immunofluorescence and electron microscopy, while the glomerular involvement was inconspicuous. The differential diagnosis from other forms of tubular basement membrane deposition is discussed.ConclusionDiffuse granular tubular basement membrane immune complex deposition with minimal glomerular involvement is also a manifestation of renal complication in hematopoietic stem cell transplantation recipient. However, the exact mechanism and target antigen remains unknown.

#4323 A RARE CASE OF MEMBRANOUS NEPHROPATHY AS THE INITIAL PRESENTATION OF SJöGREN SYNDROME

Abstract Introduction Primary Sjögren's syndrome (pSS) is an autoimmune disorder characterized by lymphocytic infiltrates in exocrine glands, most commonly manifesting as dry eyes and mouth. Even though extra glandular involvement can occur in Sjögren, renal involvement is rare. It affects less than 10% of the patient population, with tubulointerstitial nephritis being the usual presentation. Glomerular involvement and, in particular, membranous nephropathy are not commonly encountered. We describe a rare case of membranous nephropathy as the initial presentation of Primary Sjögren's syndrome. Case history A 21-year-old female with a history of sickle cell trait presented to our emergency department with one week history of anasarca. Vital signs were unremarkable, and the physical exam was significant for a 2+ pitting edema of bilateral upper and lower extremities. Initial investigation revealed acute kidney injury (Creatinine 2.9 mg/dl from normal baseline), nephrotic range proteinuria of 6 grams on 24-hour urine collection, and hypoalbuminemia (serum albumin 1.5 mg/dl). Immunological workup showed positive ANA (speckled), strongly positive anti-SSA, borderline elevated anti-SSB, negative anti-PLA2R, negative cryoglobulins, negative anti-dsDNA, and negative anti-Smith antibody (Figure 1). Renal biopsy (Figure 2) revealed membranous nephropathy with acute tubular necrosis (ATN). PLA2R staining was negative. We attributed acute kidney injury to ATN and proteinuria to membranous nephropathy. Negative serologies and renal biopsy findings ruled out systemic Lupus. The patient was therefore diagnosed with membranous nephropathy secondary to pSS. The patient was started on Mycophenolate mofetil and steroid taper with an improvement of proteinuria and anasarca and currently follows at our clinic. Discussion Glomerular involvement is rare, and when involved, it is membranoproliferative glomerulonephritis (MPGN) associated with B-cell activation and positive cryoglobulins. Membranous nephropathy is rare with primary Sjögren syndrome. In our patient, a negative anti-PLA2R goes against primary membranous nephropathy. A negative anti-dsDNA and anti-Smith and biopsy findings essentially rule out Lupus nephritis, leaving Sjögren induced secondary membranous nephropathy as the most likely diagnosis. A literature search revealed few described cases of membranous nephropathy as the presenting feature of pSS with later development of sicca symptoms and progression of renal disease to MPGN. Interestingly, our patient had no sicca symptoms at the presentation time. Occult salivary gland involvement has been described in some of these patients; however, our patient deferred salivary gland biopsy. The management of renal disease in pSS has yet to be well described because of its rarity. Rituximab has shown the most benefit in patients with pSS who have positive cryoglobulins and associated MPGN. Steroids and mycophenolate mofetil (MMF) are other possible agents that can be tried. Given that experience, we started on steroids and MMF with an excellent response to treatment indicated by improvement in proteinuria. Conclusion This case adds to the limited available literature on membranous nephropathy as the initial manifestation of pSS. Although the European Alliance of Associations for Rheumatology (EULAR) criteria strongly emphasizes sicca symptoms and glandular involvement in pSS, the possibility of a small subset of pSS patients who present with early renal involvement with latent glandular findings needs to be recognized.

#6905 PREVALENCE OF ANTIPLA2R ANTIBODIES IN EGYPTIAN PATIENTS WITH NEPHROTIC SYNDROME

Abstract Background and Aims Primary membranous nephropathy (PMN), a common form of the nephrotic syndrome, is an antibody-mediated autoimmune glomerular disease. Autoimmunity is driven by circulating autoantibodies that bind to one or more antigens on the surface of glomerular podocytes. PLA2R antigen is the most common and prevalent one among these antigens. Anti-PLA2R antibodies are measured in serum and detected within biopsies of primary membranous nephropathy patients. Up to the moment, no clear data about the prevalence of AntiPLA2R antibodies associated PMN in Egyptian patients. The aim of this work was to study the prevalence of antiPLA2R antibodies in Egyptian patients with nephrotic syndrome underwent renal biopsy. Method In this cross-sectional study we recruited 70 adult patients presented with nephrotic range proteinuria to Ain-shams university hospital and a private nephrology center in Cairo during a period of 20 months (from March 2020 to October 2021). All patients first presentation for whom laboratory investigations including serum anti-PLA2R antibodies titer by indirect immunofluorescence and kidney biopsy were done. Anti-PLA2R antibodies were measured in serum, checked in biopsies and correlated with biopsy findings. Results Membranous nephropathy (primary and secondary) was found by biopsy finding in 25 of 70 patients (35.7%) presenting with nephrotic range proteinuria. 21 patients (84%) of the cases of membranous nephropathy had been diagnosed with primary membranous nephropathy and 4 (16%) had been diagnosed with secondary membranous nephropathy. Circulating anti-PLA2R antibodies were detected within serum in 9 (42.85%) of primary MN cases while detection of anti-PLA2R antibodies within the glomerular extracts of primary MN cases was much higher; 17 patients (80.95%). There was positive correlation between serum AntiPLA2R Antibodies titer and U PCR (r = 0.839, P = 0.005) (Fig. 1). Conclusion A we may conclude that, most patients with primary membranous nephropathy have anti-PLA2R antibodies. Detection of anti-PLA2R antibodies within the biopsy has higher sensitivity than serum (80.95% versus 42.85%). Specificity of PLA2R to primary membranous nephropathy is 100%. Patients with high anti-PLA2R titer had higher baseline proteinuria than patients with lower anti-PLA2R titer.

Membranous nephropathy.

Membranous nephropathy is a glomerulopathy, which main affected target is the podocyte, and has consequences on the glomerular basement membrane. It is more common in adults, especially over 50 years of age. The clinical presentation is nephrotic syndrome, but many cases can evolve with asymptomatic non-nephrotic proteinuria. The mechanism consists of the deposition of immune complexes in the subepithelial space of the glomerular capillary loop with subsequent activation of the complement system. Great advances in the identification of potential target antigens have occurred in the last twenty years, and the main one is the protein "M-type phospholipase-A2 receptor" (PLA2R) with the circulating anti-PLA2R antibody, which makes it possible to evaluate the activity and prognosis of this nephropathy. This route of injury corresponds to approximately 70% to 80% of cases of membranous nephropathy characterized as primary. In the last 10 years, several other potential target antigens have been identified. This review proposes to present clinical, etiopathogenic and therapeutic aspects of membranous nephropathy in a didactic manner, including cases that occur during kidney transplantation.

The role of glomerular lesions in the prognosis of patients with acute kidney injury during hemorrhagic fever with renal syndrome

Objective This study aimed to explore the role of glomerular lesions in patients who suffered from acute kidney injury (AKI) during hemorrhagic fever with renal syndrome (HFRS). Methods The study comprised 66 patients with AKI during HFRS treated at the National Clinical Research Center of Kidney Diseases of China, Jinling Hospital, from January 2014 to December 2018. According to the kidney pathological findings, the 66 patients were divided into two groups: the tubulointerstitial injury group (HFRS-TI group, n = 43) and the tubulointerstitial injury with glomerular lesions group (HFRS-GL group, n = 23). The clinical and pathological characteristics of the 66 patients were analyzed. Results There were 9 cases of IgA nephropathy, 1 case of membranous nephropathy, 2 cases of diabetic nephropathy, and 11 cases of mesangial proliferative glomerulonephritis in the HFRS-GL group. There were more males in the HFRS-GL group than in the HFRS-TI group (92.3% vs. 69.8%, p < .05). A higher proportion of interstitial fibrosis (56.5% vs. 27.9%, p < .05) and more immunoglobulin and complement depositions (p < .001) were observed in the HFRS-GL group than in the HFRS-TI group. Rates of remission of AKI were lower in the HFRS-GL group than in the HFRS-TI group (73.9% vs. 95.3%, p < .05). The presence of glomerular lesions (HR = 5.636, 95% CI = 1.121–28.329, p = .036) and moderate tubulointerstitial injury (HR = 3.598, 95% CI = 1.278–10.125, p = .015) were found to be independent risk factors for kidney prognosis. Conclusions Patients with AKI during HFRS can have glomerular lesions or glomerulonephritis. Patients with AKI during HFRS who have glomerular lesions or moderate renal tubulointerstitial injury proven by kidney biopsy have a relatively poor kidney prognosis. A kidney biopsy can help determine long-term prognosis in patients with AKI during HFRS.

A case of membranous nephropathy with microspherular deposits progressing to collapsing nephropathy and dialysis dependency, but with full recovery following immunosuppression.

Membranous nephropathy with microspherular deposits is a rare renal condition associated with sub-nephrotic or nephrotic-range proteinuria. We report a case presenting with severe nephrotic syndrome and pathological features of collapsing glomerulopathy. This is the first case we are aware of that progressed to requiring dialysis. The patient received rituximab and corticosteroids. She has now been off dialysis for over a year with both serum creatinine and urine protein-creatinine ratio returning to baseline.

71 A Unique Case of Membranous Nephropathy and Proteinuria in a Patient With Common Variable Immunodeficiency Syndrome

71 A Unique Case of Membranous Nephropathy and Proteinuria in a Patient With Common Variable Immunodeficiency Syndrome

De novo posttransplant membranous nephropathy following BNT162b2 mRNA COVID-19 vaccine in a kidney transplant recipient

To the Editor: Mass COVID-19 vaccination programs in kidney transplant patients (KTRs) have demonstrated an excellent safety profile, without increased rates of ensuing alloimmune events. However, autoimmune diseases may seldom occur after vaccination. We report the case of a KTR who presented de novo posttransplant membranous nephropathy (MN) following administration of COVID-19 vaccine. A 66-year-old patient underwent first kidney transplantation for autosomal-dominant polycystic-kidney-disease-related end-stage kidney disease in June 2020. His medical history included hypertension and left nephrectomy in 2016. After basiliximab induction, the maintenance regimen consisted of tacrolimus, mycophenolic acid, and steroids. His baseline creatinine level was 100 μmol/L, and he remained free of proteinuria during the posttransplant course. A 3-month protocol graft biopsy was unremarkable. Immunohistochemistry (IHC) C4d staining was negative (Figure 1A,B). The patient received the second injection of the BNT162b2 mRNA COVID-19 vaccine (Pfizer-BioNTech) in March 2021. Subsequent serology tests showed negative results, consistent with a blunted antibody response to the vaccine, as widely reported in KTRs. Eight weeks after the second vaccine dose, the patient underwent a 1-year protocol graft biopsy. Concurrent creatinine level and proteinuria were 120 μmol/L and negative, respectively. Light microscopy showed normal glomeruli and ruled out subclinical rejection(Figure 1D). However, C4d staining revealed the presence of granular staining along the glomerular basement membrane consistent with stage 1 MN (Figure 1E). Anti-phospholipase-A2-receptor (PLA2R) immunochemistry analysis showed strong positive staining on the glomerular capillary walls (Figure 1F). Circulating PLA2R antibodies were negative. Notably, IHC staining for PLA2R and C4d was retrospectively negative in the 3-month protocol graft biopsy (Figure 1E) and in the native kidney specimen (nephrectomy). The residual renal parenchyma on the native kidney contained non-sclerotic glomeruli. We retrospectively performed Jones staining which did not show irregularities of the glomerular basement membrane suggestive of membranous nephropathy. There was no available frozen sample on the renal parenchyma. Hence, the diagnosis of de novo posttransplant MN was firmly established. Screening for malignancy and infections remained negative, excluding secondary causes of MN. COVID-19 tests remained also negative (SARS-CoV-2 PCR was negative at MN diagnosis and 3 months after the diagnosis. Anti-Spike IgG were negative 1 and 2 months after the diagnosis). This is the first case of de novo posttransplant MN following mRNA COVID-19 vaccine. Interestingly, cases of de novo or relapsing MN after COVID-19 vaccine have recently been reported.1Aydin MF Yildiz A Oruc A et al.Relapse of primary membranous nephropathy after inactivated SARS-CoV-2 virus vaccination.Kidney Int. 2021; 100 (doi:10.1016/j.kint.2021.05.001): 464-465Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar, 2Da Y Goh GH Khatri P A case of membranous nephropathy following Pfizer-BioNTech mRNA vaccination against COVID-19.Kidney Int. 2021; 100 (doi:10.1016/j.kint.2021.07.016): 938-939Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar, 3Gueguen L Loheac C Saidani N Khatchatourian L Membranous nephropathy following anti-COVID-19 mRNA vaccination.Kidney Int. 2021; S0085-2538 (doi:10.1016/j.kint.2021.08.006): 00752-00757Google Scholar Additionally, rare cases of MN (including one PLA2R+ case) have been described after COVID-19 infection.4Nasr SH Alexander MP Cornell LD et al.Kidney biopsy findings in patients with COVID-19, kidney injury, and proteinuria.Am J Kidney Dis. 2021; 77 (doi:10.1053/j.ajkd.2020.11.002): 465-468Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar The temporality between COVID-19 vaccination and PLA2R+ MN in a patient without history of MN and in whom the etiological workup has remained otherwise negative, supports a causal link. However, we must acknowledge that a coincidental association could not be ruled out. Given the lack of proteinuria, no specific treatment was introduced. The subclinical presentation of MN may be related to the mitigating effects of maintenance immunosuppressive therapy. In conclusion, auto-immune reactivity and MN may occur after mRNA COVID-19 vaccine. This report will raise awareness of nephrologists for the need to closely monitor patients with primary MN, following COVID-19 vaccination, including KTRs. If proteinuria occurs after vaccination, a graft biopsy should be promptly performed to firmly establish the diagnosis. We would like to thank Ms. Roberta Vellve for the English language review. The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation. Additional supporting information can be found online in the Supporting Information section at the end of this article. 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New-Onset and Relapsed Membranous Nephropathy post SARS-CoV-2 and COVID-19 Vaccination.

Since the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak and COVID-19 vaccination, new-onset and relapsed clinical cases of membranous nephropathy (MN) have been reported. However, their clinical characteristics and pathogenesis remained unclear. In this article, we collected five cases of MN associated with SARS-CoV-2 infection and 37 related to COVID-19 vaccination. Of these five cases, four (4/5, 80%) had acute kidney injury (AKI) at disease onset. Phospholipase A2 receptor (PLA2R) in kidney tissue was negative in three (3/5, 60%) patients, and no deposition of virus particles was measured among all patients. Conventional immunosuppressive drugs could induce disease remission. The underlying pathogenesis included the subepithelial deposition of viral antigens and aberrant immune response. New-onset and relapsed MN after COVID-19 vaccination generally occurred within two weeks after the second dose of vaccine. Almost 27% of patients (10/37) suffered from AKI. In total, 11 of 14 cases showed positive for PLA2R, and 20 of 26 (76.9%) presented with an elevated serum phospholipase A2 receptor antibody (PLA2R-Ab), in which 8 cases exceeded 50 RU/mL. Conventional immunosuppressive medications combined with rituximab were found more beneficial to disease remission for relapsed patients. In contrast, new-onset patients responded to conservative treatment. Overall, most patients (24/37, 64.9%) had a favorable prognosis. Cross immunity and enhanced immune response might contribute to explaining the mechanisms of MN post COVID-19 vaccination.

Anti-Phospholipase A2 Receptor Antibodies in Biopsy-Proven Idiopathic Membranous Nephropathy: A Report from the Pakistani Population.

This study aimed to determine the percentage of anti-phospholipase A2 receptor (PLA2R) autoantibody positivity in a cross-section of 74 Pakistani patients with biopsy-proven idiopathic membranous nephropathy. It was an observational study conducted from December 2018 to June 2019. Seventy-four (n=74) consecutive biopsy-proven cases of membranous nephropathy, aged between 12-60 years, were included. Out of them, 63.5% (n=47) were males and 36.5% (n=27) were females. The mean age was 40.2±16.7 years. Anti-PLA2R antibodies were positive in 35 (47.3%) patients, negative in 38 (51.4%) patients, and borderline positive in 1(1.35%) patient. A significant difference (p ≤ 0.05) was noted among different levels of antibodies in both genders. Anti-PLA2R antibodies were detected in approximately half of the diagnosed idiopathic membranous nephropathy cases. However, this percentage was much lower than the studies conducted on other populations around the globe, indicating a possible pathogenic role of other antigens in our population. Key Words: Membranous nephropathy, Phospholipase A2 receptors, Renal biopsy.

MO105: Study of 45 Cases of Membranous Nephropathy from a Kidney Biopsy Record at the Level of the Nephrology Department in Marrakech

Abstract BACKGROUND AND AIMS Membranous nephropathy is the most common cause of nephrotic syndrome in adults. However, the epidemiological data of this disease are not yet sufficiently known in our country. The aim of our study was to determine the clinical, biological and histological profile of MN and to evaluate its therapeutic approaches and evolutive aspects. METHOD We conducted a single-centre retrospective study in the nephrology department of the University Hospital Center Mohammed VI, over a period of 3 years (2016–2019) including 45 cases of MN confirmed by renal biopsy, with a minimum follow-up of 6 months. All patients were started on supportive therapy and then reassessed at 6 months. The nature of the next treatment was determined on an individual basis according to the risk of progression of each patient. The primary endpoint of the study was to obtain a remission of nephrotic syndrome. Complete remission was defined as proteinuria &amp;lt;0.3 g/day, and normal renal function partial remission was defined as proteinuria of 0.3–3 g /day and a stabilization of creatininemia. RESULTS The mean age of the patients was 45.24 ± 10.98 years. The clinical presentation was dominated by edematous syndrome found in 75.8% of cases. Systemic manifestations were found in 50% of cases. Nephrotic syndrome was objectified in 66.67% of cases. The histological study showed a predominance of the stage 3 in 56.7% of cases. Membranous lupus nephritis was found in 20.1% of cases, viral hepatitis B in 3% of cases, secondary syphilis in 3% of cases and primary MN in 73.9% of cases. Anti-PLA2R antibodies were positive in four patients with primary MN. After a minimal 6-month follow-up, we achieved remission in 74% of patients. Eighteen patients received aetiopathogenic treatment. Total remission was found in 48% of patients, partial in 39.4% of patients and an aggravation was noted in 15.1% of the cases progressing towards end-stage renal failure. CONCLUSION The evolution of membranous nephropathy is highly variable, but it remains a considerable cause of end-stage renal failure; hence, the need for rapid and continuous management is high in order to achieve remission and reduce the morbimortality related to membranous nephropathy.

MO221: Glomerulopathies After COVID-19 Vaccination. Report of Cases in Our Centre

BACKGROUND AND AIMSAfter the start of the vaccination campaign against the SARS-COV-2 pandemic, it is possible that the number of cases of de novo and relapsing glomerulopathies will increase.So far, most of the publications related to post-vaccination minimal change disease (also associated with other vaccines against influenza virus, hepatitis B, pneumococcus, etc.) and IgA nephropathy. However, post-vaccination cases of membranous nephropathy, ANCA vasculitis or anti-glomerular basement membrane glomerulonephritis are anecdotal.Likewise, there are no cases of segmental and focal glomerulonephritis published in the literature.We present the cases that have appeared in our centre in order to support the theory of a more than probably causal relationship. We highlight two cases of focal and segmental glomerulonephritis, making this publication the first to report this pathology post-vaccination.METHODWe present a total of 8 cases reported in our centre since the start of the vaccination campaign. We only considered cases that started with symptoms within 1 month after the first or second dose of the SARS Cov2 vaccine.Histological diagnosis was obtained in four patients with de novo glomerulopathy. In the other four patients with a flare of their baseline disease, renal biopsy was not performed. In these patients, the diagnosis of recurrence was made on the basis of laboratory and clinical data.RESULTSFive patients of the total that appeared in our centre developed minimal change disease (4 of them were recurrences and 1 de novo), 2 cases of de novo focal and segmental glomerulomephritis and 1 case of de novo IgA nephropathy.Nephrotic range proteinuria and macroscopic haematuria were the most frequent symptoms in our patients and completely reversed after immunosuppressive treatment or, in some cases, with supportive care.All of them received mRNA-based vaccines (six patients with Pfizer and two with Moderna). The mean time to onset of symptoms after vaccination was 13 days.There was no difference in sex and the mean age was 40 years.CONCLUSIONThe development of vaccines has been a key factor in the control of the SARS Cov-2 pandemic. The cases reported so far are minimal, compared with the millions of doses administered, so the benefits exceed the risks.However, according to the literature, we recommend closer follow-up in patients with known glomerulopathies and to perform renal biopsy as soon as possible after the onset of symptoms related to post-vaccination renal disease.In our centre, most of the cases appeared after the first dose of vaccination and we induced the administration of the remaining doses because all our patients did well with treatment. However, we suggested that one option might be to delay, but not to stop, the second dose in order not to interfere with the immune response to vaccination in patients who are receiving immunosuppression.