Nell1 as Target Antigen for Mercury Related Membranous Nephropathy: A Case Report

Pathak, Nabadwip; Gunasekaran, Indra; Ambriose, Moses; Nanda, Saurav Narayan

doi:10.4103/ijn.ijn_415_21

Cited by 5 publications

(2 citation statements)

References 14 publications

(24 reference statements)

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“…Various other secondary causes have been identified, including infections, graft versus host disease, allergic reactions, and drug reactions. An interesting study reported a possible association between mercury and NELL-1-associated MN [4]. NELL-1-associated MN has also been reported in patients with HIV infection [5].…”

Section: Discussionmentioning

confidence: 89%

A Rare Case of Neural Epidermal Growth Factor-Like 1 Protein (NELL-1) Antigen-Associated Membranous Nephropathy

Jiffry¹,

Pitts²,

Munir³

et al. 2023

Cureus

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Membranous nephropathy (MN) is an autoimmune disease resulting in nephrotic syndrome. Neural epidermal growth factor-like 1 protein (NELL-1) has been shown to cause a rare form of MN that is more likely to be associated with malignancy. We present a case of a 73-year-old female who was found to have a NELL-1-associated segmental MN. She presented complaining of generalized weakness, chills, and poor appetite, worsening over a one-week duration. Her kidney functions were noted to be markedly deranged, with a computed tomography scan of the abdomen showing evidence of chronic kidney disease. Further testing confirmed heavy proteinuria, although the etiology was still uncertain. A kidney biopsy revealed granular subepithelial immunoglobulin G deposits with subsequent immunohistochemical staining for NELL-1 antigen being positive. She improved with supportive care over the next few days. Despite an extensive workup, no underlying malignancy was found. NELL-1 is a rare yet recognized antigen target for the development of MN. Up to a third of patients with NELL-1-associated MN have associated cancer, thus requiring evaluation for underlying malignancy in this cohort.

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Section: Discussionmentioning

confidence: 89%

A Rare Case of Neural Epidermal Growth Factor-Like 1 Protein (NELL-1) Antigen-Associated Membranous Nephropathy

Jiffry¹,

Pitts²,

Munir³

et al. 2023

Cureus

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“…In a rare case, the use of siddha drugs have been associated with the occurrence of MN due to the presence of mercury. In such cases, notably in a NELL1 positive patient, significant improvement was achieved by discontinuing such medication [89]. Another case report described the onset of MN in a patient due to sargramostim, a recombinant granulocyte-macrophage colony-stimulating factor (GM-CSF), who recovered completely after discontinuation [90].…”

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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Discovery of seven novel putative antigens in membranous nephropathy and membranous lupus nephritis identified by mass spectrometry

Caza

Storey

Hassen

et al. 2023

Kidney International

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Nell1 as Target Antigen for Mercury Related Membranous Nephropathy: A Case Report

Cited by 5 publications

References 14 publications

A Rare Case of Neural Epidermal Growth Factor-Like 1 Protein (NELL-1) Antigen-Associated Membranous Nephropathy

A Rare Case of Neural Epidermal Growth Factor-Like 1 Protein (NELL-1) Antigen-Associated Membranous Nephropathy

How to Choose the Right Treatment for Membranous Nephropathy

Discovery of seven novel putative antigens in membranous nephropathy and membranous lupus nephritis identified by mass spectrometry

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