Membranous nephropathy in a patient with Sjögren's disease

Sjögren's disease (SjD) was first described in a middle-aged female patient with chronic rheumatism in 1930. Membranous nephropathy (MN) is the most commonly identified type of glomerulonephritis in older adults with nephrotic syndrome. One of the autoimmune diseases that causes secondary MN is SjD. A 68-year-old female patient with a medical history of 25 years of hypertension, 9 years of SjD, depressive mood disorder, and intracoronary stent placement applied with peripheral edema. Hypoalbuminemia, hypothyroidism, hematuria, proteinuria, and albuminuria were also detected. In the autoantibody panel, antinuclear antibodies, anti-Ro-52 antibody, anti-Ro/SS-related antigen A antibody, and anticentromere antibody were positive. Kidney biopsy revealed MN. Anti-phospholipase A2 receptor antibody was negative. Methylprednisolone, cyclosporine, hydroxychloroquine, nifedipine, metoprolol, valsartan, L-thyroxine, acetylsalicylic acid, artificial tear drops, and fluoxetine were administered. Partial remission was detected in the first month of treatment. However, the patient, who had all vaccinations, developed swine flu infection and subsequently widespread candidiasis, and despite amphotericin B treatment and discontinuation of immunosuppressives, died in the fifth month due to septic shock. Anti-PLA2R antibody negative MN is one of the kidney manifestations of SjD. The poor prognosis of our patient was due to high SjD disease activity and severe infectious complications, which are independent risk factors for overall mortality.