CEN Case Reports

, Volume 8, Issue 2, pp 106–111 | Cite as

A case of apolipoprotein E Toyonaka and homozygous apolipoprotein E2/2 showing non-immune membranous nephropathy-like glomerular lesions with foamy changes

  • Tamayo KatoEmail author
  • Yasuyuki Ushiogi
  • Hitoshi Yokoyama
  • Shigeo Hara
  • Akira Matsunaga
  • Eri Muso
  • Takao Saito
Case Report


A 47-year-old Japanese man with mild proteinuria was treated with an ACE inhibitor and antiplatelet agent for 7 years. However, urinary protein levels increased and renal biopsy was performed. Eight out of 20 glomeruli showed global or segmental sclerosis with foamy changes or bubbles, but with a different appearance to typical foam cells or lipoprotein thrombi. “Spike” formation, as observed in membranous nephropathy (MN), was segmentally detected in methenamine silver-stained sections. In an immunofluorescence study, weak linear patterns for IgG and scanty deposits for C3 were observed in glomeruli, but were not specific for immunogenetic MN. An electron microscopy study showed highly dense deposits in the subepithelial, subendothelial, and mesangial areas, in which microbubbles appeared under a higher magnification. Since this case exhibited hypertriglyceridemia and cholesterolemia with high serum apolipoprotein E (apoE) clinically and homozygous apoE2/2 by apoE phenotype and genotype analyses, apoE2 homozygote glomerulopathy was diagnosed and various lipid-lowering agents, e.g., probucol, fenofibrate, and ezetimibe, were administered. However, renal dysfunction gradually developed and peritoneal dialysis was initiated 11 years after the diagnosis. ApoE Toyonaka (Ser197Cys) and homozygous E2/2 were recently identified by direct DNA sequencing. Therefore, non-immune MN-like lesions may develop with the combination of these apoE mutations.


Apolipoprotein E Toyonaka Homozygous apolipoprotein E2/2 Apo E2 homozygote glomerulopathy Lipoprotein glomerulopathy Membranous nephropathy 




Compliance with ethical standards

Conflict of interest

None of the authors have any competing interests to declare.

Human rights

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

Written informed consent was obtained from the patient before the commencement of the phenotype and gene analyses of apoE.


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Copyright information

© Japanese Society of Nephrology 2019

Authors and Affiliations

  1. 1.Department of NephrologyFukuiken Saiseikai HospitalFukuiJapan
  2. 2.Department of NephrologyKanazawa Medical University School of MedicineUchinadaJapan
  3. 3.Department of PathologyKobe City Medical Center General HospitalKobeJapan
  4. 4.Department of Laboratory MedicineFukuoka University School of MedicineFukuokaJapan
  5. 5.Division of Nephrology and Dialysis, Kitano HospitalTazuke Kofukai Medical InstituteOsakaJapan
  6. 6.Department of Food and Nutrition, Faculty of Contemporary Home EconomicsKyoto Kacho UniversityKyotoJapan
  7. 7.Sanko ClinicFukuokaJapan

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