A case of membranous nephropathy secondary to asymptomatic Graves’ disease

Moniwa, Norihito; Shioya, Yu; Gocho, Yufu; Takahashi, Satoko; Tanaka, Marenao; Furuhashi, Masato; Hama, Taketsugu; Shima, Yuko; Ogawa, Yoshihide; Miura, Tetsuji

doi:10.1007/s13730-021-00672-0

Cited by 3 publications

(1 citation statement)

References 12 publications

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“…In cases secondary to ankylosing spondylitis, the use of adalimumab (40 mg/2 weeks), a tumor necrosis factor (TNF)-alpha antagonist, significantly improved proteinuria [93]. Treatment of Grave's-disease-associated MN has been successful with thiamazole, while others have reported improvement after radioiodine thyroid ablation but not after drug therapy [94][95][96]. However, in patients with myasthenia gravis and MN, treatment options include steroids, ACTH (which has been shown to achieve partial remission), RTX and, finally, thymectomy [97].…”

Section: Treatment Of Secondary Membranous Nephropathymentioning

confidence: 99%

How to Choose the Right Treatment for Membranous Nephropathy

Peritore,

Labbozzetta,

Maressa

et al. 2023

Medicina

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Membranous nephropathy is an autoimmune disease affecting the glomeruli and is one of the most common causes of nephrotic syndrome. In the absence of any therapy, 35% of patients develop end-stage renal disease. The discovery of autoantibodies such as phospholipase A2 receptor 1, antithrombospondin and neural epidermal growth factor-like 1 protein has greatly helped us to understand the pathogenesis and enable the diagnosis of this disease and to guide its treatment. Depending on the complications of nephrotic syndrome, patients with this disease receive supportive treatment with diuretics, ACE inhibitors or angiotensin-receptor blockers, lipid-lowering agents and anticoagulants. After assessing the risk of progression of end-stage renal disease, patients receive immunosuppressive therapy with various drugs such as cyclophosphamide, steroids, calcineurin inhibitors or rituximab. Since immunosuppressive drugs can cause life-threatening side effects and up to 30% of patients do not respond to therapy, new therapeutic approaches with drugs such as adrenocorticotropic hormone, belimumab, anti-plasma cell antibodies or complement-guided drugs are currently being tested. However, special attention needs to be paid to the choice of therapy in secondary forms or in specific clinical contexts such as membranous disease in children, pregnant women and patients undergoing kidney transplantation.

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Section: Treatment Of Secondary Membranous Nephropathymentioning

confidence: 99%

How to Choose the Right Treatment for Membranous Nephropathy

Peritore,

Labbozzetta,

Maressa

et al. 2023

Medicina

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Oxidative stress and inflammation are mediated via aryl hydrocarbon receptor signalling in idiopathic membranous nephropathy

Wang

Miao

et al. 2023

Free Radical Biology and Medicine

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Membranous Nephropathy Secondary to Graves’ Disease: A Case Report

et al. 2022

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Membranous nephropathy (MN) is a form of kidney disease that is idiopathic in 70%–80% of cases. Glomerular involvement in autoimmune thyroiditis can occur in 10%–30% of patients, and MN manifests in association with Hashimoto thyroiditis in up to 20% of the cases with glomerular involvement. Reports of MN associated with Graves’ disease (GD) are extremely rare in the current literature. Herein, we report the case of a 46-year-old man admitted to the hospital with nephrotic syndrome and symptomatic hyperthyroidism due to GD. Kidney biopsy revealed a secondary MN pattern. Immunohistochemical staining for PLA2R was negative, and thyroglobulin showed weak and segmental staining along the glomerular capillary. Anti-thyroid peroxidase (TPO) antibody test was not performed. The patient was treated for GD with methimazole and prednisone, and despite reaching clinical improvement after 8 months, proteinuria remained close to nephrotic levels. In this scenario, the patient was submitted to radioactive iodine, and there was a dramatic reduction in proteinuria levels after treatment. In conclusion, GD association with MN is rare, and when present, diagnosis using PLA2R and immunohistochemistry can be useful in determining association. In addition, radioactive iodine therapy can be an effective treatment modality when preceded with immunosuppressive corticosteroid therapy.

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A case of membranous nephropathy secondary to asymptomatic Graves’ disease

Cited by 3 publications

References 12 publications

How to Choose the Right Treatment for Membranous Nephropathy

How to Choose the Right Treatment for Membranous Nephropathy

Oxidative stress and inflammation are mediated via aryl hydrocarbon receptor signalling in idiopathic membranous nephropathy

Membranous Nephropathy Secondary to Graves’ Disease: A Case Report

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