SHM Converge Scientific Abstract ePoster Gallery-Secondary Syphilitic Surprise: An Atypical Cause of Acute Nephrotic Syndrome

Pdf Summary

This case report describes a 50-year-old woman who presented after syncope and was found to have acute nephrotic syndrome. Her exam showed new ankle edema, and labs revealed elevated creatinine, severe hypoalbuminemia, and nephrotic-range proteinuria with a urine protein/creatinine ratio of 26.7 g/g. Urine microscopy showed granular and WBC casts. <br /><br />Further evaluation identified a strongly positive RPR (1:256) and positive treponemal antibodies, while workup for other causes of nephrotic syndrome was negative, including HIV, hepatitis B and C, ANCA, anti-GBM antibodies, and monoclonal protein studies. Complement levels were normal. She reported no prior history of syphilis and no symptoms of primary infection. <br /><br />A lumbar puncture was performed to assess for neurosyphilis; CSF VDRL was negative. She was diagnosed with secondary syphilis causing membranous nephropathy and nephrotic syndrome. She was treated with a single intramuscular dose of penicillin G and discharged with antiproteinuric therapy and follow-up to monitor renal recovery.<br /><br />The report highlights that syphilis is a rare but important reversible cause of secondary membranous nephropathy. Because syphilis incidence is rising, clinicians should consider it in the evaluation of nephrotic syndrome even when patients do not report a classic history of primary syphilis. Recent research also suggests a novel antigen, neuron-derived neurotrophic factor (NDNF), may be involved in syphilis-associated membranous nephropathy.

Asset Subtitle

Jennifer Li

Meta Tag

Author List Elizabeth Moss, Jennifer Li, Jonathan Heyman, Toby Terwilliger

Category Clinical Vignettes

Concept Membranous Nephropathy

Concept Nephrotic Syndrome

Concept Secondary Membranous Nephropathy

Concept Syphilis

Concept Proteinuria

Distinguished Non-Finalist

Presenter Organization Emory University School of Medicine

Presenting Author Jennifer Li

Track Adult

Keywords

secondary syphilis

membranous nephropathy

nephrotic syndrome

proteinuria

hypoalbuminemia

RPR positive

penicillin G

renal recovery

neurosyphilis

NDNF

Membranous Nephropathy

Nephrotic Syndrome

Secondary Membranous Nephropathy

Syphilis

Proteinuria