Vascular Threads and Nephron Nests: Exploring the Association Between Takayasu Arteritis and Membranous Nephropathy

Area of Science:

• Nephrology
• Rheumatology
• Vascular Medicine

Background:

• Takayasu arteritis (TA) typically causes kidney ischemia but can involve glomerulopathy.
• Membranous nephropathy (MN) is an autoimmune kidney disease.
• The co-occurrence of MN and TA is rare and challenging to diagnose.

Purpose of the Study:

• To report a unique case of MN preceding TA in a young female.
• To highlight the diagnostic challenges and management of this rare condition.
• To emphasize the need for considering TA in patients with MN.

Main Methods:

• Case report of a young female with refractory PLA2-receptor-negative, THSD7A-positive MN.
• Clinical presentation included neck pain and hypertension.
• Diagnostic workup involved inflammatory markers and vascular imaging.
• Treatment involved steroids and mycophenolate mofetil.

Main Results:

• The patient presented with MN symptoms before TA diagnosis.
• Vascular imaging confirmed Takayasu arteritis.
• Treatment with steroids and mycophenolate mofetil resolved nephrotic syndrome and symptoms.
• This is the first reported case in a young female with THSD7A-positive MN and TA.

Conclusions:

• Diagnosing coexisting MN and TA is challenging due to distinct presentations, potentially causing delays.
• A multidisciplinary approach is essential for timely diagnosis and tailored management.
• Further research is needed to understand the pathogenesis and optimize treatment for this rare condition.