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Kidney and Dialysis
Volume 6
Issue 3
10.3390/kidneydial6030046
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Case Report

Successful Dialysis Weaning in Refractory Membranous Nephropathy Through Long-Term Multi-Disciplinary Management: A Case Report

by
Reina Suetsugu-Ishizawa
1,
Megumi Matsumoto
1,
Hirofumi Sakuma
1,2,
Motoki Matsuki
1,
Mitsuru Yanai
3,
Yayoi Ogawa
3 and
Naoki Nakagawa
1,*
1
Division of Cardiology and Nephrology, Department of Internal Medicine, Asahikawa Medical University, 2-1-1-1 Midorigaoka-Higashi, Asahikawa 078-8510, Hokkaido, Japan
2
Department of Integrative Nephrology and Therapeutics, Asahikawa Medical University, 2-1-1-1 Midorigaoka-Higashi, Asahikawa 078-8510, Hokkaido, Japan
3
Department of Pathology, Sapporo Tokushukai Hospital, Sapporo 004-0041, Hokkaido, Japan
*
Author to whom correspondence should be addressed.
Kidney Dial. 2026, 6(3), 46; https://doi.org/10.3390/kidneydial6030046
Submission received: 21 May 2026 / Revised: 29 June 2026 / Accepted: 2 July 2026 / Published: 3 July 2026
Versions Notes

Abstract

Membranous nephropathy (MN) is a leading cause of nephrotic syndrome (NS). The remission rate of MN remains limited, and effective strategies for refractory MN are not established. We present the case of a 49-year-old Japanese woman with severe NS caused by MN. Kidney biopsy revealed glomerular basement membrane thickening with granular deposition of immunoglobulin G (IgG) and complement component 3. IgG subclass analysis showed predominant IgG1 deposition, with weak IgG2 and IgG3 deposition. Phospholipase A2 receptor (PLA2R) deposition was equivocal in the first kidney biopsy and negative in the second. Serum anti-PLA2R antibody was not detected. Electron microscopy revealed subepithelial, subendothelial, and mesangial electron-dense deposits. Detailed screening revealed no significant abnormalities other than appendiceal findings, suggesting secondary MN associated with appendiceal infection. Although combined therapy with prednisolone, cyclosporine, rituximab, and low-density lipoprotein apheresis was administered during the first 6 months, remission of MN was not achieved. During dialysis, initiated because of kidney failure, long-term multidisciplinary management, including control of appendiceal infection and inflammation and initiation of angiotensin II receptor blocker therapy, ultimately led to remission of MN and discontinuation of dialysis. Overall, even refractory MN requiring dialysis may have a reversible clinical course with careful conservative management and long-term follow-up.
Keywords: nephrotic syndrome; membranous nephropathy; dialysis nephrotic syndrome; membranous nephropathy; dialysis

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MDPI and ACS Style

Suetsugu-Ishizawa, R.; Matsumoto, M.; Sakuma, H.; Matsuki, M.; Yanai, M.; Ogawa, Y.; Nakagawa, N. Successful Dialysis Weaning in Refractory Membranous Nephropathy Through Long-Term Multi-Disciplinary Management: A Case Report. Kidney Dial. 2026, 6, 46. https://doi.org/10.3390/kidneydial6030046

AMA Style

Suetsugu-Ishizawa R, Matsumoto M, Sakuma H, Matsuki M, Yanai M, Ogawa Y, Nakagawa N. Successful Dialysis Weaning in Refractory Membranous Nephropathy Through Long-Term Multi-Disciplinary Management: A Case Report. Kidney and Dialysis. 2026; 6(3):46. https://doi.org/10.3390/kidneydial6030046

Chicago/Turabian Style

Suetsugu-Ishizawa, Reina, Megumi Matsumoto, Hirofumi Sakuma, Motoki Matsuki, Mitsuru Yanai, Yayoi Ogawa, and Naoki Nakagawa. 2026. "Successful Dialysis Weaning in Refractory Membranous Nephropathy Through Long-Term Multi-Disciplinary Management: A Case Report" Kidney and Dialysis 6, no. 3: 46. https://doi.org/10.3390/kidneydial6030046

APA Style

Suetsugu-Ishizawa, R., Matsumoto, M., Sakuma, H., Matsuki, M., Yanai, M., Ogawa, Y., & Nakagawa, N. (2026). Successful Dialysis Weaning in Refractory Membranous Nephropathy Through Long-Term Multi-Disciplinary Management: A Case Report. Kidney and Dialysis, 6(3), 46. https://doi.org/10.3390/kidneydial6030046

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