AUTHOR=Barbosa Géssica Sabrine Braga , Neves Precil Diego Miranda de Menezes , Mohrbacher Sara , Abdo André Néder Ramires , Cavalcante Lívia Barreira , Menezes Yara de , Sato Victor Augusto Hamamoto , Oliveira Érico de Souza , Pereira Leonardo Victor Barbosa , Bales Alessandra Martins , Frediani Marcella Martins , Chocair Pedro Renato , Cuvello-Neto Américo Lourenço 

TITLE=Overlap of membranous nephropathy and IgA nephropathy in a patient with Kimura’s disease: a case report and literature review

JOURNAL=Frontiers in Immunology

VOLUME=Volume 15 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2024.1404954

DOI=10.3389/fimmu.2024.1404954

ISSN=1664-3224

ABSTRACT=Introduction: Kimura's disease (KD) is a rare chronic inflammatory disorder characterized by subcutaneous lymphoid hyperplasia with peripheral eosinophilia. Kidney involvement is reported in 15-18% adult patients with KD, in many cases as nephrotic syndrome. We present a case of overlapping Membranous Nephropathy and IgA Nephropathy associated with KD.Case report: A 27-year-old man was admitted with a history of bilateral leg edema for the last two months and concomitant progressive increase of cervical mass and fever. Laboratory findings: peripheral leukocyte count, 10080/mm³; eosinophils, 3200/mm³ (31.7%); serum creatinine, 0.83mg/dL; eGFR: 140ml/min per 1.73m 2 . In the urinalysis, presence of hematuria and proteinuria; 24-hour proteinuria: 12.9g; serum albumin, 1.3g/dL; elevated IgE level (750kU/L). Serologies for hepatitis B, hepatitis C, HIV and VDRL were all negative.Complement C3 and C4 levels were normal. No monoclonal protein was detected in blood and urine. Parasite infestation was discarded. A biopsy of the cervical lymph node revealed eosinophilic lymphoid hyperplasia, suggesting KD. A kidney biopsy revealed findings consistent with overlapping of Membranous Nephropathy with IgA nephropathy. The patient was treated for KD with prednisone 1mg/kg/d with progressive dose tapering and posterior association of methotrexate 15mg/week. A renin-angiotensin system inhibitor was prescribed for nephrotic syndrome. The cervical mass regressed, and proteinuria achieved partial remission, with an increase in serum albumin level and normalization of eosinophils and IgE levels.Although uncommon, kidney involvement must be kept in mind in patients with Kimura's disease. Glomerular diseases are the most frequent form of kidney injury.