Idiopathic Membranous Nephropathy: Diagnostic and Therapeutic Challenges

Background: In adults, membranous nephropathy (MN) is a major cause of nephrotic syndrome. While a majority of cases of MN are idiopathic, secondary forms can be seen in the setting of autoimmune disease, neoplasia, infection, and after being exposed to certain therapeutic agents. Both human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections could cause MN. However, the effect of coexisting HIV and HCV infection on the spectrum and progression of kidney disease as well as the effect of MN treatment on HIV and HCV infection are not well known. Methods: In this study, we describe a patient with hemophilia A and acquired HIV and HCV infections, a patient who developed severe nephrotic syndrome and for whom renal biopsy showed MN. Results: Patient responded well to adrenocorticotropic hormone gel without adversely affecting HIV or HCV infections. Conclusion: Adrenocorticotropic hormone gel might be useful in the management of complex cases of idiopathic MN.