Epitope Spreading: The Underlying Mechanism for Combined Membranous Lupus Nephritis and Anti-GBM Disease?

Olusola Sogbein; Tina Kochar; Marjan Afrouzian

doi:10.1155/2023/3190042

Epitope Spreading: The Underlying Mechanism for Combined Membranous Lupus Nephritis and Anti-GBM Disease?

Case Rep Nephrol. 2023 Jan 24:2023:3190042. doi: 10.1155/2023/3190042. eCollection 2023.

Authors

Olusola Sogbein¹, Tina Kochar¹, Marjan Afrouzian^{1

2}

Affiliations

¹ Department of Internal Medicine, Division of Nephrology and Hypertension, University of Texas Medical Branch, Galveston, Texas, USA.
² Department of Pathology, University of Texas Medical Branch, Galveston, Texas, USA.

Abstract

Membranous lupus nephritis associated with anti-GBM antibodies is a rare entity, particularly in lupus nephritis patients who are serologically negative for ANA and anti-dsDNA with normal complement levels. We present an unusual case of a patient initially diagnosed with anti-GBM disease whose repeat biopsy demonstrated combined focal proliferative and membranous lupus nephritis (III + V). The first biopsy showed a granular linear pattern, and the second biopsy had multiple electron dense deposits in the subendothelial, epithelial, and mesangial regions along with podocyte effacement. Experimental research suggests that the sequential histopathological transition observed may reflect the action of immunological rearrangement and epitope spreading.

Publication types

Case Reports