Kidney Week

Abstract: PUB377

Syphilis as a Cause of Secondary Membranous Nephropathy

Session Information

• Publication Only

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Maya-Quinta, Rogelio, Tecnologico de Monterrey Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, Mexico

Rogelio Maya-Quinta, DrMed

• Del Bosque-Aguirre, Adolfo, Tecnologico de Monterrey Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, Mexico

Adolfo Del Bosque-Aguirre, MD, MS

• Henriquez, Fanny Y., Tecnologico de Monterrey Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, Mexico

Fanny Y. Henriquez, RDN

• Garcia Zubizar, Mariana G., Tecnologico de Monterrey Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, Mexico

Mariana G. Garcia Zubizar

• Sardarli, Kamil, University of California San Diego, La Jolla, California, United States

Kamil Sardarli, MD

Introduction

Membranous nephropathy (MN) can arise from secondary and congenital syphilis. In these cases, immunofluorescence microscopy demonstrates the presence of treponemal antigens within the glomeruli, indicating direct antigen involvement and a immunological response against these within the kidney. Effective treatment of syphilis can lead to the resolution of MN without commonly used immunosuppressive
medications.

Case Description

50-year-old male with no medical history presents with progressive lower extremity and genital edema for 4 weeks. Labs reported creatinine 0.8 mg/dl, albumin 1.1 mg/dl, cholesterol 282 mg/dl, UA with 3+ protein, and a 24-hour urine protein of 43.92 g.

He was given single 500 mg dose of methylprednisolone IV due to suspicion of a primary MN. Subsequently, the patient presented a rash characterized by erythematous macules on the palms and soles, as well as non-painful ulcers with erythematous base and irregular borders in the genitalia. Additional labs showed normal complement levels, negative ANCA panel, negative ANAs, negative anti-PLA2R, negative HBsAg and anti-HCv, negative HIV, negative QuantiFERON and a positive VDRL (1:16) with reactive FTA-ABS.

A renal biopsy was performed and reported histopathologic characteristics of MN with sclerosing scarring segmental lesions and treponemal antigen deposits. Benzathine penicillin G was given once a week for three consecutive weeks. The patient had a favorable response with partial reduction of the edema and proteinuria; therefore, he was discharged. However, due to persisting residual edema an additional course with dicloxacillin was given, resulting in complete resolution of symptoms and illness remission.

Discussion

In patients with unexplained glomerulonephritis or proteinuria, syphilis should be considered as a possible cause. Accurate diagnosis and prompt treatment can resolve kidney issues without immunosuppressants.

Glomerulus with treponemal antigen deposits