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Nell1 as Target Antigen for Mercury Related Membranous Nephropathy: A Case Report
Nabadwip Pathak1, Indra Gunasekaran2, Moses Ambriose2
1Department of Nephrology, Pondicherry Institute of Medical Science, Pondicherry, India.
Abstract:
Membranous nephropathy constitutes 30% of adult nephrotic syndrome. Of all cases of membranous nephropathy, primary membranous nephropathy is commonest. Mercury is known to be a cause of secondary membranous nephropathy. There is no human data on the pathophysiology of mercury-related membranous nephropathy, but animal studies suggested an autoimmune mechanism behind it. There is no data to the best of our knowledge about target antigen for mercury-related membranous nephropathy. We are reporting a case of NELL-1 positive mercury-related membranous nephropathy that started resolving after stopping siddha medication and taking antiproteinuric. There was also concomitant euthyroid lymphocytic thyroiditis with anti-TPO positive, which started after exposure to siddha medication, which suggests systemic autoimmune phenomenon due to mercury exposure.
Insights
Mercury exposure can cause membranous nephropathy, a kidney disease, potentially through an autoimmune process. This case report identifies NELL-1 as a possible target antigen in mercury-related kidney damage.
Area of Science:
- Nephrology
- Toxicology
- Immunology
Background:
- Membranous nephropathy is a leading cause of nephrotic syndrome in adults, with primary forms being most common.
- Mercury exposure is a known cause of secondary membranous nephropathy, but human pathophysiology and target antigens remain unclear.
- Animal studies suggest an autoimmune mechanism underlies mercury-induced membranous nephropathy.
Observation:
- A case of mercury-related membranous nephropathy was observed.
- The patient presented with NELL-1 positivity.
- Concomitant euthyroid lymphocytic thyroiditis with anti-TPO antibodies was noted after mercury exposure from Siddha medication.
Findings:
- The patient's condition improved after discontinuing Siddha medication and initiating antiproteinuric therapy.
- This case suggests NELL-1 as a potential target antigen in mercury-induced membranous nephropathy.
- The co-occurrence of thyroiditis suggests a broader systemic autoimmune phenomenon triggered by mercury exposure.
Implications:
- This report provides novel human data on the pathophysiology of mercury-related membranous nephropathy.
- Identifying NELL-1 as a potential antigen aids in understanding disease mechanisms and developing targeted therapies.
- The findings highlight the importance of considering mercury exposure in secondary nephropathies and associated autoimmune conditions.
