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Published on: April 13, 2021
Rethinking Proteinuria: Resolution of Donor Derived EXT2-Associated Membranous Nephropathy Following Renal
Mike Fruscione1,2, Devarsh Desai2, Satoru Kudose3
1Division of Organ Transplantation, Hackensack Meridian Hackensack University Medical Center, Hackensack, New Jersey, USA.
Case Reports in Transplantation
|July 1, 2026
Summary
Kidney transplantation successfully treated Exostosin-2 (EXT2)-associated membranous nephropathy (MN). The procedure resolved immune deposits and improved recipient renal function and proteinuria, demonstrating transplantation
Area of Science:
- Nephrology
- Immunology
- Transplantation Medicine
Background:
- Exostosin-2 (EXT2)-associated membranous nephropathy (MN) is an immune complex-mediated renal disease.
- Transplantation is explored as a potential treatment to clear immune deposits in EXT2-associated MN.
- Donor kidneys may present with proteinuria and hypoalbuminemia in EXT2-associated MN.
Purpose of the Study:
- To present a successful kidney transplantation case for a recipient with EXT2-associated membranous nephropathy.
- To evaluate the efficacy of kidney transplantation in resolving immune deposits and improving renal function in this specific condition.
Main Methods:
- A kidney from a 19-year-old deceased donor with undiagnosed EXT2-associated MN was transplanted into a 75-year-old male recipient.
- Pre-transplant donor kidney assessment included evaluation of proteinuria and renal architecture.
- Recipient's renal function and proteinuria were monitored post-transplantation.
Main Results:
- The donor kidney showed well-preserved architecture despite pre-transplant proteinuria.
- Recipient's serum creatinine decreased significantly from 3.56 mg/dL to 0.96 mg/dL within 2 months post-transplant.
- Nephrotic-range proteinuria resolved to subnephrotic levels by 4 months, with normalized renal function at 6 months.
Conclusions:
- Kidney transplantation can facilitate the resolution of immune complex-mediated glomerulopathy, including EXT2-associated MN.
- Removing the kidney from its native pro-inflammatory environment, alongside immunosuppression, aids in disease clearance.
- This case highlights the potential benefit of transplantation in managing EXT2-associated membranous nephropathy.
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