A Case of NELL-1-Positive Membranous Nephropathy With Acute Kidney Injury Due to Bilateral Renal Vein Thrombosis

Membranous nephropathy (MN) is a significant cause of nephrotic syndrome in non-diabetic adults. It can be primary, attributed to autoantibodies targeting podocyte antigens, or secondary to various disorders. Although rare, nerve epidermal growth factor-like 1 (NELL-1)-associated MN presents diagnos...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2024-05, Vol.16 (5), p.e61230
Main Authors: Kashiv, Pranjal, Malde, Sunny, Gupta, Sushrut, Dubey, Shubham, Sejpal, Kapil N, Pawar, Twinkle, Mahajan, Vrushali, Gurjar, Prasad, Pasari, Amit, Balwani, Manish
Format: Article
Language:English
Subjects:
Abdomen
Antigens
Biopsy
Blood clots
Case reports
Creatinine
Drug dosages
Edema
Epidermal growth factor
Hemoglobin
Kidney diseases
Microscopy
Nephrology
Nonsteroidal anti-inflammatory drugs
Patients
Proteins
Stem cells
Thromboembolism
Thrombosis
Transplants & implants
Urine
Veins & arteries
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Summary:Membranous nephropathy (MN) is a significant cause of nephrotic syndrome in non-diabetic adults. It can be primary, attributed to autoantibodies targeting podocyte antigens, or secondary to various disorders. Although rare, nerve epidermal growth factor-like 1 (NELL-1)-associated MN presents diagnostic and management challenges. Thrombotic complications such as renal vein thrombosis (RVT) are recognized but less reported, especially in NELL-1-positive MN. We report a 43-year-old male with NELL-1-positive MN complicated by acute kidney injury (AKI) due to bilateral RVT, treated successfully with thrombolysis. Histopathological analysis confirmed MN with specific immunohistochemical staining for NELL-1. Treatment included immunosuppressive therapy and tailored anticoagulation. This case emphasizes recognizing thrombotic complications in MN, particularly in NELL-1-positive cases. Further research is needed to explore serum anti-NELL-1 antibodies as biomarkers and optimal anticoagulation strategies in MN patients at risk of thrombotic events to improve outcomes and guide personalized management.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.61230