Wang JL, Sun YL, Kang Z, Zhang SK, Yu CX, Zhang W, Xie H, Lin HL. Anti-phospholipase A2 receptor-associated membranous nephropathy with human immunodeficiency virus infection treated with telitacicept: A case report. World J Clin Cases 2023; 11(22): 5309-5315 [PMID: 37621578 DOI: 10.12998/wjcc.v11.i22.5309]
Corresponding Author of This Article
Hong-Li Lin, PhD, Chief Physician, Department of Nephrology, The First Affiliated Hospital of Dalian Medical University, No. 222 Zhongshan Road, Dalian 116000, Liaoning Province, China. linhongli1216@163.com
Research Domain of This Article
Urology & Nephrology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Aug 6, 2023; 11(22): 5309-5315 Published online Aug 6, 2023. doi: 10.12998/wjcc.v11.i22.5309
Anti-phospholipase A2 receptor-associated membranous nephropathy with human immunodeficiency virus infection treated with telitacicept: A case report
Jin-Ling Wang, Yan-Ling Sun, Zhe Kang, Sheng-Kun Zhang, Chun-Xin Yu, Wan Zhang, Hua Xie, Hong-Li Lin
Jin-Ling Wang, Yan-Ling Sun, Zhe Kang, Sheng-Kun Zhang, Chun-Xin Yu, Wan Zhang, Hua Xie, Department of Nephrology, Dalian Renal Care Hospital, Dalian 116000, Liaoning Province, China
Hong-Li Lin, Department of Nephrology, The First Affiliated Hospital of Dalian Medical University, Dalian 116000, Liaoning Province, China
Author contributions: Wang JL, Sun YL, Kang Z, Zhang SK, Yu CX, Zhang W, and Xie H participated in the acquisition of clinical data; Lin HL, Wang JL, Sun YL, and Xie H carried out analysis of patient’s clinical course and data interpretation; Wang JL and Lin HL wrote a draft of the manuscript; Sun YL and Kang Z prepared figures; Zhang SK, Yu CX, Zhang W, and Xie H revised it critically; All authors read and approved the final manuscript.
Informed consent statement: The informed consent form was signed by patient.
Conflict-of-interest statement: The authors declare that there were no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong-Li Lin, PhD, Chief Physician, Department of Nephrology, The First Affiliated Hospital of Dalian Medical University, No. 222 Zhongshan Road, Dalian 116000, Liaoning Province, China. linhongli1216@163.com
Received: March 2, 2023 Peer-review started: March 2, 2023 First decision: June 12, 2023 Revised: July 7, 2023 Accepted: July 17, 2023 Article in press: July 17, 2023 Published online: August 6, 2023
Abstract
BACKGROUND
The co-occurrence of Anti-phospholipase A2 receptor-associated membranous nephropathy (anti-PLA2R-MN) and human immunodeficiency virus (HIV) infection is a rare clinical scenario, presenting significant challenges in terms of management and treatment.
CASE SUMMARY
A 32-year-old Chinese male diagnosed with HIV infection presented with a clinical history of proteinuria persisting for over two years. A kidney biopsy demonstrated subepithelial immune complex deposition and a thickened glomerular basement membrane, indicative of stage I-II membranous nephropathy. Immunofluorescence staining revealed granular deposition of PLA2R (3+) along the glomerular capillary loops, corroborated by a strongly positive anti-PLA2R antibody test (1:320). Initial treatment involving losartan potassium, rivaroxaban, tacrolimus, and rituximab was discontinued due to either poor effectiveness or the occurrence of adverse events. Following a regimen of weekly subcutaneous injections of telitacicept (160 mg), a marked decline in the 24 h urine protein was observed within a three-month period, accompanied by a rise in serum albumin level. No significant reductions in peripheral blood CD3+CD4+T and CD3+CD8+T cell counts were detected. The patient's physical and psychological conditions showed significant improvements, with no adverse events reported during the treatment course.
CONCLUSION
Telitacicept might offer a potential therapeutic avenue for patients diagnosed with anti-PLA2R-MN concomitant with HIV infection.
Core Tip: The clinical management of anti-phospholipase A2 receptor-associated membranous nephropathy concurrent with human immunodeficiency virus infection presents significant challenges, primarily due to potential unregulated immune responses. In this report, we demonstrated that a weekly subcutaneous injection of telitacicept (160 mg) could ameliorate the 24-h urinary protein levels and enhance serum albumin concentrations, with no discernible impact on T cell counts, showcasing its safety profile.
