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Idiopathic membranous nephropathy and synchronous mononeuritis multiplex secondary to idiopathic small vessel

Kalpa Jayanatha1,2, Ashutosh Kumar2, Mark Sapsford3

  • 1Medicine, The University of Auckland, Auckland, New Zealand kalpa.jayanatha@auckland.ac.nz.

BMJ Case Reports
|February 29, 2024
PubMed

Insights

This study details a rare case of idiopathic membranous nephropathy occurring simultaneously with small vessel vasculitis, presenting as neuropathy. Effective treatment with rituximab and methylprednisolone led to remission of both conditions.

Area of Science:

  • Nephrology
  • Neurology
  • Immunology

Background:

  • Membranous nephropathy is typically linked with demyelinating polyneuropathies.
  • An association between membranous nephropathy and vasculitic neuropathy is not well-documented.

Observation:

  • A patient presented with biopsy-proven idiopathic membranous nephropathy.
  • The patient also had synchronous mononeuritis multiplex due to idiopathic small vessel vasculitis.
  • Symptoms included lower limb microvascular ischemia, peripheral neuropathy, and active urinary sediment.

Findings:

  • Extensive screening ruled out other immunological diseases and occult malignancy.
  • The patient received intravenous methylprednisolone and rituximab induction therapy.
  • Complete remission of both idiopathic membranous nephropathy and small vessel vasculitis was achieved at 7 months.

Implications:

  • This case highlights a potential, previously undescribed association between membranous nephropathy and vasculitic neuropathy.
  • It underscores the importance of considering vasculitis in patients with membranous nephropathy and neurological symptoms.
  • Successful treatment with rituximab and corticosteroids suggests a viable therapeutic strategy for this combined condition.
Keywords:
Clinical neurophysiologyImmunologyProteinureaRenal medicineVasculitis

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