Mercury-induced membranous nephropathy: clinical and pathological features

Abstract

Background and objectives: Long-term contact with mercury may induce membranous nephropathy (MN); however, the clinical pathologic features and pathogenesis of mercury-induced MN have not been investigated.

Design, setting, participants, & measurements: The present study retrospectively evaluated 11 cases of mercury-induced MN to analyze its causes and its clinical and pathologic features.

Results: A total of 10 women and 1 man ages 15 to 45 years were enrolled in the present study. Mercury exposure was caused by mercury-containing pills (five patients), skin lightening cream (four patients), hair-dyeing agents (one patient), and mercury vapor (one patient). The duration of contact with mercury ranged from 2 to 60 months, and the urinary mercury concentrations were 1.5 to 50 times higher than reference values. All patients presented with proteinuria and normal renal function; three had nephrotic syndrome. Light microscopy revealed thickened glomerular basement membrane and mildly proliferative mesangial cells. Acute tubulointerstitial injury occurred in three patients. The immunofluorescence findings showed granular deposits of IgG and C3 along the glomerular capillary wall, mostly accompanied by deposits of C4 and C1q. IgG1 and IgG4 (predominantly IgG1) deposits were observed along the glomerular capillary loops. Nine patients reached complete remission in follow-up after withdrawal from mercury exposure.

Conclusions: Deposits of IgG1 subclasses in renal tissues indicated that the pathogenesis of mercury-induced MN differs from that of idiopathic MN. It is important that clinicians are aware that mercury exposure should be considered a possible cause of membranous nephropathy.

Figure 1.

Pathologic findings in mercury-induced MN. (A) Thickened glomerular basement membrane, as well as subepithelial fuchsinophilic deposits along the epithelium. Patient no. 2 (PASM staining; magnification, ×400). (B) Loss of the tubular brush border and focal concentration of interstitial infiltrating cells. Patient no. 10 (periodic acid-Schiff staining; magnification, ×400). (C) Deposits of IgG1 in the glomerular basement membrane (2+). Patient no. 2 (immunofluorescence staining; magnification, ×400). (D) Deposits of IgG4 in the glomerular basement membrane (1+). Patient no. 2 (immunofluorescence staining; magnification, ×400).