Membranous Nephropathy- Over the Counter? NELL Yes!

Author(s): Umair Ali, Neriman Gokden, John Arthur, Manisha Singh.

In adults, membranous Nephropathy (MN) is a common cause of idiopathic nephrotic syndrome. Primary MN is caused by antibodies directed against podocyte antigens, while secondary MN with the deposition of circulating immune complexes in the same area of glomeruli. Most of the primary membranous are positive for PLA2R- and THSD7Aantibodies associated with the progression of the disease. Some novel antibodies like NELL 1 indicate primarily secondary causes, including malignancy but may sometimes present as a primary disease with no underlying reason or ingestion of lipoic acid. Our patient presented to the hospital with a rash and swelling of lower limbs, which was sudden in onset. With a history of diabetes mellitus with comorbidities, he used multiple medications, including over-the-counter supplements (lipoic acid). Renal biopsy revealed NELL 1 positivity likely secondary to overthe- counter supplement usage.