NELL-1 as a Target Antigen in Asbestosis Associated Membranous Nephropathy - A Case Report

Our plain-English summary of NELL-1 as a Target Antigen in Asbestosis Associated Membranous Nephropathy - A Case Report, by B. Sundaram, N. Pathak, M.M. Ambroise, et al (Indian Journal of Nephrology, 2025).

The study

• Authors: B. Sundaram, N. Pathak, M.M. Ambroise, S.M. Papou
• Journal: Indian Journal of Nephrology
• Published: 2025;35(1):103-105
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

An 80-year-old male with a history of prolonged asbestos exposure presented with 24-hour urine protein of 8 gm, and serum albumin of 1.7 gm/dl. Renal biopsy disclosed features of membranous nephropathy. Immunohistochemistry showed positivity for neural epidermal-like growth factor- like 1 (NELL1) (2+/3+). Further assessment uncovered an incidental finding of asbestos-related pleural plaques and left hemithorax volume loss on computed tomography (CT) chest, leading to a diagnosis of asbestosis. This case highlights the rare association between asbestosis and NELL-1 positive membranous nephropathy.

© 2025 Indian Journal of Nephrology | Published by Scientific Scholar.

In plain English

This was a case report of one patient. An 80-year-old man had swelling of the lower legs and around the eyes for 10 days. He had worked as military personnel for 35–40 years and lived in a house with asbestos roofing for over 30 years; no fiber type was named. Tests showed 8 gm of protein in 24-hour urine and serum albumin of 1.7 gm/dl. A kidney biopsy showed membranous nephropathy, and staining was positive for the protein NELL-1 (2+/3+). A chest CT scan, done to look for cancer, showed calcified pleural plaques and loss of volume in the left side of the chest. Based on this and his asbestos exposure, a diagnosis of asbestosis was made, though he had no breathing complaints. After no response to steroids, he reached complete remission after 6 weeks of tacrolimus with prednisolone. The authors concluded that, to their knowledge, this was the first report of NELL-1 positive membranous nephropathy associated with asbestosis, warranting further investigation. One case cannot show how often this happens.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 80-year-old man with lower limb swelling and swelling around the eyes for 10 days. The article does not state where or when he was seen. The authors are from institutions in Pondicherry and Bathinda, India.
• Exposure: Work as military personnel for 35–40 years, and living in a house with asbestos roofing for over 30 years. Later in the text the roofing exposure is given as almost 35–40 years. No fiber type is named.
• Main results:
  • In this patient, 24-hour urine protein was 8 gm and serum albumin was 1.7 gm/dl. Serum creatinine was 0.9 mg/dl.
  • The kidney biopsy showed thickening of the glomerular basement and stiffening of the glomerular capillaries in all glomeruli.
  • Immunohistochemistry tested several target antigens and showed diffuse NELL-1 positivity (2+/3+) along the glomerular capillaries.
  • A chest CT, done to exclude malignancies, showed calcified pleural plaques and loss of volume in the left hemithorax.
  • A diagnosis of asbestosis was made based on the asbestos exposure and the CT findings. The patient had no respiratory complaints.
  • The patient had no breathing complaints.
  • The patient did not respond to steroid at 1 mg/kg. He was then given tacrolimus with prednisolone and reached complete remission after 6 weeks of therapy.
• The authors' conclusion: The authors concluded that, to their knowledge, this was the first report of NELL-1 positive membranous nephropathy associated with asbestosis, and that the association warrants further investigation into its pathophysiological significance and possible treatment implications.

Topics

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Biopsy, Immunohistochemistry, Pleural Plaques, Hemithorax.

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