CASE REPORT


Membranous Nephropathy Associated with Atheroembolism



Kiyotaka Uchiyama1, *, Tamiko Takemura2, Yoshitaka Ishibashi1
1 Division of Nephrology, Japanese Red Cross Medical Center, Tokyo, Japan
2 Division of Pathology, Japanese Red Cross Medical Center, Tokyo, Japan


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© 2017 Uchiyama et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at Division of Nephrology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan; Tel: +81-3-3400-1311; Fax: +81-3-3409-1604; E-mail: kiyo.0817.piyo@gmail.com


Abstract

Membranous nephropathy (MN) is one of the most common biopsy diagnoses in adults, and it has been associated with chronic infections, autoimmune diseases, malignancies, and drugs. However, MN associated with cholesterol crystal emboli has never been reported. Here we present a patient with MN as an unusual manifestation of atheroembolism.

A 75-year-old man with worsening renal function after catheter ablation developed moderate proteinuria and underwent a renal biopsy. Findings on light, immunofluorescence, and electron microscopy were all compatible with membranous nephropathy. Moreover, one occluded interlobular artery contained a pathognomonic, biconvex, needle-shaped cleft, which indicated a cholesterol crystal emboli. The degree of proteinuria was in parallel with the number of eosinophils, which indicated a close relationship between MN disease activity and renal atheroembolism. Hypereosinophilic syndrome secondary to atheroembolism may cause MN; thus, corticosteroid therapy was likely to be effective.

Keywords: Anti-phospholipase A2 receptor antibodies, Atheroembolism, Hypereosinophilic syndrome, Membranous nephropathy, Proteinuria.