DMSA-induced membranous nephropathy in a patient with Wilson's disease: Case report

"Given the widespread use of DMSA for Wilson's disease treatment, further research is required to fully understand the potential role of this drug in the development of membranous nephropathy," Xiang Li, The Second Affiliated Hospital of Nanchang University, Nanchang, P.R. China, and colleagues wrote in their study.

Wilson's disease (W.D.) is an inherited disorder that leads to excessive accumulation of copper in the brain, liver, and other organs. The accumulation of toxic amounts of copper in the brain, liver, and other organs may cause various clinical conditions, often with prominent psychiatric, neurological, and liver-related symptoms.

DMSA is chelation therapy for Wilson's disease patients. The treatment promotes copper excretion in these patients. There have been reports of DMSA-associated side effects, but the development of membranous nephropathy due to this therapy is uncommon.

The report describes a patient with Wilson's disease who received long-term DMSA treatment and developed proteinuria, later confirmed through renal biopsy as membranous nephropathy. The patient was successfully treated with glucocorticoids.

The case concerns a 19-year-old male patient with Wilson's disease who experienced proteinuria while receiving long-term treatment with DMSA. Further evaluation showed abnormally low serum ceruloplasmin levels, serum albumin, and 24-hour urinary protein excretion of 4599.98 mg/24 h.

A renal biopsy confirmed the presence of membranous nephropathy. After ruling out other potential causes, it was determined that DMSA likely caused the patient's membranous nephropathy. The patient was treated with glucocorticoids, after which a significant proteinuria reduction was seen.

"We report a rare case of membranous nephropathy resulting from dimercaptosuccinic acid in a patient with Wilson's disease," the authors wrote. "DMSA are now widely used in the W.D. treatment and can lead to side effects on kidneys, which are rarely reported and may go unrecognized."

The authors noted that diagnosing DMSA-induced secondary membranous nephropathy is challenging and requires proper laboratory work-up and histological testing. They suggested further studies to evaluate and comprehend DMSA's role in this condition.

"In addition, we should use drugs cautiously according to drug safety and patient risk factors and make timely judgments and active treatment when side effects occur," they concluded. "The case will provide a reference for side effects caused by DMSA."

Reference:

Li, X., Hu, F. & Xu, G. Membranous nephropathy caused by dimercaptosuccinic acid in a patient with Wilson's disease: a case report and literature review. BMC Nephrol 24, 147 (2023). https://doi.org/10.1186/s12882-023-03201-6