Drug-Induced Membranous Nephropathy: Piecing Together Clues to Understand Disease Mechanisms.
| Title: | Drug-Induced Membranous Nephropathy: Piecing Together Clues to Understand Disease Mechanisms. |
|---|---|
| Authors: | Avasare RS; Division of Nephrology and Hypertension, Oregon Health and Science University, Portland, Oregon.; Andeen NK; Department of Pathology, Oregon Health and Science University, Portland, Oregon.; Al-Rabadi LF; Division of Nephrology, Department of Medicine, University of Utah, Salt Lake City, Utah.; Burfeind KG; Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, Oregon.; Beck LH Jr; Section of Nephrology, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts. |
| Source: | Journal of the American Society of Nephrology : JASN [J Am Soc Nephrol] 2025 Apr 08; Vol. 36 (8), pp. 1629-1638. Date of Electronic Publication: 2025 Apr 08. |
| Publication Type: | Journal Article; Review |
| Language: | English |
| Journal Info: | Publisher: Wolters Kluwer Health, on behalf of the American Society of Nephrology Country of Publication: United States NLM ID: 9013836 Publication Model: Electronic Cited Medium: Internet ISSN: 1533-3450 (Electronic) Linking ISSN: 10466673 NLM ISO Abbreviation: J Am Soc Nephrol Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2023- : Hagerstown, MD : Wolters Kluwer Health, on behalf of the American Society of Nephrology; Original Publication: Baltimore, MD : Williams & Wilkins, c1990- |
| MeSH Terms: | Glomerulonephritis, Membranous*/chemically induced ; Glomerulonephritis, Membranous*/immunology ; Glomerulonephritis, Membranous*/pathology; Penicillamine/adverse effects ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects ; Mercury/adverse effects ; Humans |
| Abstract: | There is a resurgence of interest in drug-induced membranous nephropathy because of the widespread availability of recently discovered culprit medications, such as lipoic acid supplements, mercury in skin-lightening creams, and nonsteroidal anti-inflammatory drugs, and the relationship between these drugs and newly described target antigens. The clinical syndromes associated with drug-induced membranous nephropathy are similar in that proteinuria ranges from low grade to nephrotic range and generally remits within months of drug cessation. Histology is notable for subepithelial deposits that are IgG1 subclass predominant, sometimes with a unique segmental distribution. The two antigens associated with drug-induced membranous nephropathy are neural epidermal growth factor-like 1 and proprotein convertase subtilisin/kexin type 6. Notably, several of the culprit drugs contain one or more sulfhydryl groups that may have potential mechanistic relevance. In this review, we explore past research investigations into mechanisms of membranous nephropathy associated with gold salts, penicillamine, and mercury and use these historical studies as the basis for formulating new hypotheses on how drugs might promote immune dysregulation and, ultimately, membranous nephropathy.; (Copyright © 2025 by the American Society of Nephrology.) |
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| Grant Information: | K23 DK135855 United States DK NIDDK NIH HHS; K23DK135855 United States DK NIDDK NIH HHS |
| Contributed Indexing: | Keywords: drug nephrotoxicity; glomerular disease; membranous nephropathy |
| Substance Nomenclature: | GNN1DV99GX (Penicillamine); 0 (Anti-Inflammatory Agents, Non-Steroidal); FXS1BY2PGL (Mercury) |
| Entry Date(s): | Date Created: 20250408 Date Completed: 20250801 Latest Revision: 20260121 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC12342100 |
| DOI: | 10.1681/ASN.0000000719 |
| PMID: | 40198910 |
| Database: | MEDLINE |
Journal Article; Review