Early-Childhood Membranous Nephropathy Due to Cationic Bovine Serum Albumin

• Published in: The New England journal of medicine Vol. 364; no. 22; pp. 2101 - 2110
• Main Authors: Debiec, Hanna, Lefeu, Florence, Kemper, Markus J, Niaudet, Patrick, Deschênes, Georges, Remuzzi, Giuseppe, Ulinski, Tim, Ronco, Pierre
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 02.06.2011
• Subjects: Adolescent; Adult; Age; Animals; Antigen-antibody complexes; Antigens; Biological and medical sciences; Biopsy; Bovine serum albumin; Cations; Child; Child, Preschool; Childhood; Children; Chromatography; Cohort Studies; Enzyme-Linked Immunosorbent Assay; Epitope Mapping; Gel electrophoresis; General aspects; Glomerulonephritis; Glomerulonephritis, Membranous - immunology; Humans; Immunoglobulin G; Immunoglobulin G - blood; Immunoglobulins; Medical sciences; Membranous nephropathy; Milk - immunology; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Nephropathy; Nephrotic syndrome; Pathogenesis; Phospholipase A2; Proteins; Serum Albumin, Bovine - adverse effects; Serum Albumin, Bovine - analysis; Serum Albumin, Bovine - immunology; Sodium lauryl sulfate; Statistical analysis; Western blotting; France; Human; Kidney disease; Urinary system disease; Bovine; Serum albumin; Medicine; Vertebrata; Mammalia; Early; Membranous glomerulonephritis; Artiodactyla; Child; Ungulata
• ISSN: 0028-4793; 1533-4406; 1533-4406
• DOI: 10.1056/NEJMoa1013792

BSA ingested in food can escape the intestinal barrier and induce antibovine serum albumin antibodies. The authors of this study identified circulating BSA in patients with membranous nephropathy and in immune deposits in four children. Membranous nephropathy is the most common cause of the nephrotic syndrome in adults but is rare in children. 1 , 2 The central pathogenesis involves the formation of subepithelial immune deposits that are responsible for functional impairment of the glomerular capillary wall. 1 , 3 Two major antigens have been identified. The first is neutral endopeptidase, the alloantigen involved in neonatal cases of membranous nephropathy, 4 and the second is the M-type phospholipase A 2 receptor (PLA 2 R), which has been identified in idiopathic membranous nephropathy. 5 Idiopathic membranous nephropathy is considered an autoimmune disease, whereas secondary forms involve exogenous antigens such as viral, bacterial, . . .