Abstract: PUB038
Syphilis-Associated Membranous Nephropathy
Session Information
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Jenkinson, Patrick J., University of Michigan, Ann Arbor, Michigan, United States
- Tareen, Hafsa Khan, Aga Khan University Hospital Clinical Laboratories, Karachi, Federal Capital Territory, Pakistan
- Wagner, Benjamin R., University of Michigan, Ann Arbor, Michigan, United States
Introduction
Syphilis, known as “The Great Masquerader,” can present with a myriad of systemic manifestations. Renal sequelae have been documented, though rarely. Here, we report a case of biopsy-proven syphilis-associated membranous nephropathy.
Case Description
A 35-year-old man with a history of well-controlled HIV presented with six weeks of fatigue, arthralgias, headache, neck stiffness, lower extremity edema, and a diffuse maculopapular rash – including over the palms and soles. He was ultimately diagnosed with secondary syphilis, complicated by aseptic meningitis, for which IV penicillin G was initiated. Upon presentation, he was found to have new onset nephrotic-range proteinuria with urine protein/creatinine ratio 4.49. Creatinine was normal and at the patient's baseline. Kidney biopsy was performed to investigate his heavy proteinuria. Light microscopy of the glomerular basement membranes revealed pinhole defects on silver stain. Immunofluorescence demonstrated an IgG and C1q dominant membranous glomerulopathy that was negative for PLA2R. Electron microscopy showed scattered, subendothelial electron dense deposits along with diffuse podocyte foot process effacement. There was no evidence of HIVAN. After a two-week course of penicillin G, the patient achieved complete remission, with urine protein/creatinine ratio 0.28.
Discussion
According to the CDC, the incidence of syphilis is at its highest rate since 1950, and continues to rise. Despite this, renal sequelae of syphilis may be under-recognized due to a lack of awareness among clinicians. Syphilis-associated membranous nephropathy is due to immune complex-mediated podocyte injury. Treponemal antigens – among others – have been identified as causative. Prompt initiation of penicillin G can lead to reversal of kidney injury, including complete resolution of nephrotic-range proteinuria.