Abstract: TH-PO670
Alpha Lipoic Acid-Associated NELL1-Positive Membranous Nephropathy
Session Information
- Glomerular Diseases: Case Reports - 1
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Ali, Mohammed Omer Khalil, University of Missouri-Kansas City, Kansas City, Missouri, United States
- Shah, Jignesh, University of Missouri-Kansas City, Kansas City, Missouri, United States
- Shaban, Ehsan, University of Missouri-Kansas City, Kansas City, Missouri, United States
Introduction
Membranous nephropathy (MN) is one of the leading causes of nephrotic syndrome in adults and involves an autoimmune response against various antigens, such as PLA2R, THSD7A, NELL1, Sema3B, and NCAM1. Notably, there are increased cases of MN triggered by antibodies against NELL1 following exposure to alpha-lipoic acid (ALA) supplements, which are over-the-counter antioxidant supplements for multiple sclerosis, diabetic neuropathy, and schizophrenia. This report presents a case of NELL1-positive MN nephropathy likely caused by exposure to ALA, emphasizing early recognition and good outcomes without immunosuppression.
Case Description
70-year-old male with diabetes mellitus and hypertension was referred due to concerns about nephrotic syndrome with leg swelling, foamy urine and neuropathic pain. He had been taking 2400 mg of alpha-lipoic acid daily for a year to help with his diabetic neuropathy. Physical examination was notable for bilateral severe pedal edema. Laboratory investigations revealed normal complete blood counts, creatinine, urea, and basic electrolytes. His hemoglobin A1C level was 7%, His albumin level was low at 2.4 g/dl and his cholesterol was elevated at 224 mg/dl , with LDL cholesterol at 120 mg/dl . Urine protein-to-creatinine ratio increased to 6.4 g/g. Additional tests, including serologies for ANA, ANCA, Hepatitis B surface Ag, Hepatitis C Ab, urine protein electrophoresis and serum PLA2R antibodies levels were negative. The kidney biopsy revealed NELL-1 positive Membranous Nephropathy-. Patient underwent age-appropriate malignancy screening with CT chest, abdomen and pelvis which showed no remarkable findings, normal PSA level and a screening colonoscopy was unremarkable.The Patient’s NELL-1 positive MN is related to Alpha lipoic acid use, hence it was discontinued, he was on ARB and diuretic at tolerated dose. Three months later, the patient reported resolution of his edema and he is in partial remission of his proteinuria with levels of 2.5 g/g without any immunosupressive agents.
Discussion
ALA has the most substantial evidence of the therapeutic effect in diabetic neuropathy and oxidative stress conditions. Growing data suggests a correlation between MN and (ALA) supplements. The limited literature consists of a few case reports that note the association between lipoic acid and MN and more areas to investigate the pathogenesis behind such correlation.