Abstract: TH-PO577
Membranous Nephropathy Associated with Alemtuzumab
Session Information
- Glomerular Diseases: From Inflammation to Fibrosis - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1401 Glomerular Diseases: From Inflammation to Fibrosis
Authors
- Ravender, Raja, The University of New Mexico, Albuquerque, New Mexico, United States
- Pal, Chaitanya A., The University of New Mexico, Albuquerque, New Mexico, United States
- Kodavanti, Chandra Kumar Mallick, The University of New Mexico, Albuquerque, New Mexico, United States
- Shaffi, Saeed Kamran, The University of New Mexico, Albuquerque, New Mexico, United States
- Schmidt, Darren W., The University of New Mexico, Albuquerque, New Mexico, United States
- Teixeira, J. Pedro, The University of New Mexico, Albuquerque, New Mexico, United States
- Caza, Tiffany, Arkana Laboratories, Little Rock, Arkansas, United States
- Garcia, Pablo, The University of New Mexico, Albuquerque, New Mexico, United States
Group or Team Name
- UNMH/Arkana Team.
Introduction
Alemtuzumab is a humanized anti-CD52 monoclonal antibody approved for multiple sclerosis. We present a case of membranous nephropathy associated with alemtuzumab use.
Case Description
A 20-year-old woman with a seven-year history of multiple sclerosis was referred to nephrology due to new-onset nephrotic range proteinuria nine months after receiving her first cycle of alemtuzumab. She took no other medications. Vitals were stable with trace lower extremity edema. Spot urine protein- and albumin- to creatinine ratios were 4.63 g/g and 3481 mg/g, respectively. Serum creatinine was 0.4 mg/dL with serum albumin 2.1 g/dL. Hepatitis B and C, HIV, C3 and C4 complement, kappa/lambda ratio, anti-GBM antibody, rheumatoid factor, antinuclear antibody, antineutrophil cytoplasmic antibody, and anti-phospholipase A2 receptor (PLA2R) antibody were all negative. Renal biopsy revealed membranous nephropathy, with negative immunohistochemical stains for PLA2R, thrombospondin type-1 domain-containing 7A, exostosin 2, and neural epidermal growth factor-like 1. Alemtuzumab was held. Rituximab was initiated as it is effective for membranous nephropathy or multiple sclerosis, and we await the renal and neurologic response.
Discussion
Alemtuzumab depletes B and T lymphocytes and can produce side effects associated with immune reconstitution, with thyroid toxicity seen in up to 30% of patients. However, nephrotoxicity is rare (5/1485 patients, 0.3%). Mechanisms underlying kidney-related side effects from alemtuzumab use are not fully understood but may be linked to the anti-CD52 immunomodulatory effect on B and T cell lymphocytes. The autoimmune diseases observed after administering alemtuzumab are predominantly antibody-mediated and appear to respond to B-cell depletion, suggesting that rituximab may be a potentially effective therapy.