A case of Gitelman syndrome with membranous nephropathy

Abstract

Background Gitelman syndrome (GS) is a rare autosomal recessive inherited salt-losing tubulopathy (SLT). Here, we report, for the first time, a case of GS overlapping nephrotic syndrome (NS) related to PLA2R-associated membranous nephropathy (MN). Case presentation We described a male patient had a 4-year history of recurrent fatigue. Serum biochemistry revealed hypokalemia with renal potassium wasting, hypomagnesemia, metabolic alkalosis, hyperreninemia, hypocalciuria, as well as nephrotic-range proteinuria, hypoalbuminemia, and elevated serum anti-phospholipase A2 receptor (PLA2R) antibody. Gene sequencing identified compound heterozygous mutations in SLC12A3 [c.536T > A(p.V179D) and c.1456G > A(p.D486N)]. The unusual association of SLTs and nephrotic-range glomerular proteinuria prompted us to perform a renal biopsy. Renal biopsy showed idiopathic MN. Due to the potential to activate the sodium-chloride co-transporter (NCC) and cause hyperkalemia, tacrolimus was selected to treat NS. Following treatment with potassium chloride, magnesium oxide, low-dose glucocorticoid combined with tacrolimus, the fatigue significantly improved, and concurrently hypokalemia, hypomagnesemia were corrected and NS was remitted. Conclusions Renal biopsy should be warranted for GS patients with moderate to nephrotic-range proteinuria. Tacrolimus was preferred to the management of GS patients with NS.

Clinicopathological Features of Gitelman Syndrome with Proteinuria and Renal Dysfunction

“…Besides the manifestations of renal tubulopathy, GS is also accompanied by proteinuria [2][3][4][5][6][7][8][9][10][11][12], renal dysfunction [7][8][9][13][14][15][16], and even renal failure requiring renal replacement [17][18][19]. To date, only 19 cases of GS with renal pathology data have been reported which indicated chronic tubulointerstitial injury [1,10,13,14,19], C1q nephropathy (C1qN), focal segmental glomerulosclerosis (FSGS), minimal change disease (MCD), severe podocyte detachment, diabetic nephropathy, and membranous nephropathy [2, 4-9, 12, 15, 16].…”