Membranous nephropathy complicated by immune thrombocytopenia treated with low-density lipoprotein apheresis: a case report and literature review

Abstract

Immune thrombocytopenia (ITP) may lead to membranous nephropathy (MN). Here, we report a case of MN complicated by ITP and validate the hypothesis that circulating antiplatelet antibodies cause MN using immunofluorescence analysis for immunoglobulin (Ig) G subclass and anti-phospholipase A2 receptor (PLA2R) antibodies. A 39-year-old Japanese man with ITP, who had been treated with prednisolone for 10 months, achieved a stable disease condition. However, 4 months after tapering the dose down to 10 mg prednisolone, he developed nephrotic syndrome, with a urinary protein-to-creatinine ratio (U-PCR) of 10.6 g/g Cr and was admitted to our hospital. His platelet count, at 89,000/μL, was lower than the normal range, indicating the recurrence of ITP. Renal biopsy revealed the thickening of the glomerular basement membrane with the deposition of IgG and complement component 3. Predominant deposition of IgG1 and negativity for anti-PLA2R staining indicated secondary MN; however, no typical conditions of secondary MN were evident. Although oral prednisolone and cyclosporine A were administered, he was refractory to treatment. A total of 12 sessions of low-density lipoprotein apheresis (LDL-A) decreased his U-PCR to < 3 g/g Cr. Seven months after discharge, his U-PCR further decreased to 0.54 g/g Cr and platelet count recovered to > 200,000/μL. Our literature review reveals that this condition is refractory to steroid therapy. LDL-A can be an effective treatment in drug-resistant MN complicated by ITP.

Incidence and Clinical Pattern of Mixed Connective Tissue Disease in Sudanese Patients at Omdurman Military Hospital: Hospital-Based Study

“…The overall 10-year survival rate is about 80%, but the prognosis depends largely on which manifestations predominate. 12 , 13 The aim of this study is to identify the frequency and patterns of mixed connective tissue disease to characterize his epidemiology in Sudanese patients.…”

Immune Thrombocytopenia Could be an Independent Clinical Phenotype of Antiphospholipid Syndrome: A Prospective Cohort Study

“…In our cohort, no clinical signs of nephropathy were found in aPLs carriers with thrombocytopenia. Lande et al [17] and Nishizawa et al [18] reported cases of membranous nephropathy complicated by ITP, but the aPLs profile was not further elucidated. The proportion of each separate kind of aPLs was similar between the two groups, except that LA was more frequent in thrombocytopenic APS patients but lacked statistical significance.…”

Successful treatment of coexisting membranous nephropathy and immune thrombocytopenia by eradicating gastric Helicobacter pylori infection: a case report

“…Several cases have previously reported a link between MN as well as ITP and were treated using prednisolone [ 19 ], a combination of prednisolone with immunosuppressive therapy [ 15 , 16 ], rituximab [ 20 ], or low-density lipoprotein apheresis [ 21 ]. However, there are no reports on patients with coexisting MN and ITP whose condition improved after gastric Helicobacter pylori infection eradication.…”