Secondary membranous nephropathy with detection of PLA2R in a patient with chronic recurrent cholangitis

Membranous nephropathy (MN) is a variant of glomerulopathy characterized by diffuse thickening and restructuring of the glomerular basement membrane as a result of subepithelial and intramembranous deposition of immune complexes and deposition of matrix material produced by affected podocytes. MN is one of the most common causes of nephrotic syndrome in adults (20-40% of cases). Secondary MN develops against the background of autoimmune diseases, tumors, infections, drug exposures, etc. The determination of antibodies to PLA2R can be used as an informative test for the diagnosis of MN and the differential diagnosis of its primary and secondary forms. It is known that antibodies to PLA2R are detected in 70-80% of patients with primary MN. In secondary MN, detection of antibodies to PLA2R is rare, and a feature of this clinical observation is the anti-PLA2R positivity of our patient. The article describes a clinical observation of a 69-year-old patient with nephrotic syndrome, with a morphologically confirmed diagnosis of MN and the detection of anti-PLA2R antibodies. However, a secondary genesis of MN was established. During the diagnostic search, the main causes of secondary MR were excluded. The reason for the development of secondary MR, in this case, was chronic recurrent cholangitis against the background of stricture of the common bile duct with frequent exacerbations. Descriptions of MN against the background of autoimmune diseases of the hepatobiliary system can be found in literature, but not often. Cases of association of MN with chronic cholangitis of bacterial origin have not been described yet, but there are isolated observations of secondary MN against the background of other bacterial infections. Despite the detection of antibodies to PLA2R and morphological confirmation of MN, immunosuppressive therapy was not performed in this patient due to the risk of developing septic complications and the supposed secondary nature of nephropathy. The patient was recommended surgical treatment. After endoprosthesis replacement of the choledochus the patient's condition improved, nephrotic syndrome regressed and the level of antibodies to PLA2R decreased significantly, which confirms the secondary genesis of the disease.

хронический гломерулонефрит, вторичная мембранозная нефропатия, хронический бактериальный холангит, антитела к PLA2R, нефротический синдром, ремиссия, chronic glomerulonephritis, secondary membranous nephropathy, chronic bacterial cholangitis, antibodies to PLA2R, nephrotic syndrome, remission

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