Metuku Rajesh, Wynn Austin B, Santos Raul
Research Department, Alabama College of Osteopathic Medicine, Dothan, USA.
Nephrology, Archbold Hospital, Alabama College of Osteopathic Medicine, Thomasville, USA.
Cureus. 2024 Dec 3;16(12):e75057. doi: 10.7759/cureus.75057. eCollection 2024 Dec.
Membranous nephropathy due to a positive PLA2R marker is an idiopathic cause of membrane nephropathy, characterized as an autoimmune attack on the kidney at the PLA2R receptor. Autoantibodies attack the PLA2R receptor, leading to nephrotic syndrome and eventually leading to end-stage renal failure, as in our case. We present a case that involves a patient who presented to the nephrology clinic with nephrotic range proteinuria and a history of HIV. The biopsy was prompted by nephrotic syndrome, where we saw clear evidence of sclerotic and fibrotic damage along with positive anti-PLA2R antibodies. The patient was put on tacrolimus and cyclophosphamide to halt the damage, but the patient eventually had to be put on dialysis later on. What makes this case unique is the patient is dealing with both the PLA2R antibodies and HIV, which increases the complexity of the treatment and our understanding of what played a bigger role in kidney failure. It is unique cases like these that prompt us to research further about these pathologies and develop new treatment options that result in a better prognosis.
磷脂酶A2受体（PLA2R）标志物阳性所致的膜性肾病是膜性肾病的一种特发性病因，其特征为在PLA2R受体处对肾脏发起自身免疫攻击。自身抗体攻击PLA2R受体，导致肾病综合征，并最终导致终末期肾衰竭，就像我们这个病例一样。我们报告一例患者，该患者因肾病范围蛋白尿前往肾病科就诊，并有HIV病史。肾病综合征促使进行活检，在此我们看到了硬化和纤维化损伤的明确证据以及抗PLA2R抗体阳性。该患者接受了他克莫司和环磷酰胺治疗以阻止损伤，但患者最终还是不得不接受透析治疗。该病例的独特之处在于患者同时患有PLA2R抗体和HIV，这增加了治疗的复杂性以及我们对肾衰竭中何种因素起更大作用的理解。正是像这样的独特病例促使我们进一步研究这些病理情况，并开发出能带来更好预后的新治疗方案。
