Unveiling Renal Lipid Deposition: A Rare Case of Hepatic Glomerulosclerosis Resembling Lecithin-Cholesterol Acyltransferase (LCAT) Deficiency Post Liver Transplantation

Abstract

Hepatic glomerulosclerosis, a renal complication of liver cirrhosis, presents challenges in diagnosis and management. This case report discusses the rarity of kidney biopsy findings resembling lecithin-cholesterol acyltransferase (LCAT) deficiency post liver transplantation. We present the case of a patient with end-stage liver disease (ESLD) from alcohol-related cirrhosis, who underwent orthotopic liver transplantation (OLT) with persistent proteinuria after transplantation. Kidney biopsy revealed features of hepatic glomerulopathy resembling both IgA nephropathy (IgAN) and LCAT deficiency. The histopathological similarities between hepatic glomerulosclerosis and LCAT deficiency suggest a potential link between liver disease and lipid deposition in the kidneys. The clinical course and outcomes of such renal alterations post liver transplantation remain uncertain, highlighting the need for further research in glomerular pathology in the context of liver transplantation. This case underscores the importance of kidney biopsy in ESLD patients and the necessity for more attention to glomerular pathology post liver transplantation, especially in the current era of increasing liver transplantation rates.

Keywords: hepatic glomerulosclerosis; lcat deficiency; lipid deposits; liver cirrhosis; liver transplant.

Figure 1. Proteinuria time course

Figure 2. (A) H&E 400×: glomerulus with calcifications and foamy macrophage in the mesangial area. (B) von Kossa calcium stain 400×: glomerulus with calcifications. (C) von Kossa calcium stain 200×: peritubular calcium deposits. (D) EM with intramembranous, subendothelial, and mesangial partly osmiophilic partly lucent deposits consistent with lipid material

H&E: hematoxylin and eosin; EM: electron microscopy

Figure 3. Genetic testing