Successful Treatment of Coexisting Membranous Nephropathy and Immune Thrombocytopenia by Eradicating Gastric Helicobacter Pylori Infection: a Case Report

Overview

Journal CEN Case Rep

Specialty Nephrology

Date 2023 Jul 8

PMID 37421572

Authors

Reina Suetsugu

Hirofumi Sakuma

Keisuke Maruyama

Motoki Matsuki

Yayoi Ogawa

Naoki Nakagawa

Affiliations

Soon will be listed here.

Abstract

Membranous nephropathy (MN) is a common cause of nephrotic syndrome in middle-aged and older adults. MN etiology is mainly primary or idiopathic; however, it may also be secondary to infections, drugs, neoplasms, and autoimmune diseases. We present the case of a 52-year-old Japanese man with coexisting nephrotic MN and immune thrombocytopenic purpura (ITP). Renal biopsy revealed glomerular basement membrane thickening with immunoglobulin (Ig) G and complement component 3 deposition. Glomerular IgG subclass analysis revealed predominant IgG4 deposition with weak IgG1 and IgG2 deposition. IgG3 and phospholipase A2 receptor deposits were negative. Upper endoscopy revealed no ulcers, but histological examination demonstrated Helicobacter pylori infection in the gastric mucosa with elevated IgG antibodies. After gastric Helicobacter pylori eradication, the nephrotic-range proteinuria and thrombocytopenia of the patient were markedly improved without initiation of immunosuppressive treatment. Therefore, clinicians should consider the possibility of Helicobacter pylori infection in patients with coexisting MN and ITP. Further studies are required to demonstrate the associated pathophysiological aspects.

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