Complementary medicine and phospholipase A2 receptor (PLA2R)-related membranous nephropathy-fortuitous or causal?

We read with interest the article by Kurien et al. highlighting enhanced neural epidermal growth factor-like 1 (NELL-1) expression with complementary and alternative medicine (CAM)–associated membranous nephropathy (MN). 1 Kurien A.A. Prema K.S.J. Walker P.D. Caza T.N. Traditional indigenous medicines are an etiologic consideration for NELL1-positive membranous nephropathy. Kidney Int. 2022; 102: 1424-1426 Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar An association between intake of heavy metals and development of MN has been well described. 2 Kumar M.N. Priyamvada P.S. Chellappan A. et al. Membranous nephropathy associated with indigenous Indian medications containing heavy metals. Kidney Int Rep. 2020; 5: 1510-1514 Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar ,3 Doshi M. Annigeri R.A. Kowdle P.C. et al. Membranous nephropathy due to chronic mercury poisoning from traditional Indian medicines: report of five cases. Clin Kidney J. 2018; 12: 239-244 Crossref PubMed Scopus (13) Google Scholar Herein, we highlight a novel association of CAM with phospholipase A2 receptor (PLA2R)–related MN. The authors replyKidney InternationalVol. 103Issue 2PreviewWe found the case reported in the letter by Kaur et al.1 quite interesting. The authors present a patient with phospholipase A2 receptor (PLA2R)–positive membranous nephropathy (MN) in temporal association with complementary medicine containing strontium (Sr2+).1 Several heavy metals have been implicated in MN, most commonly mercury.2,3 Others are (and are not limited to) lead, cadmium, gold salts, silver, and platinum.4 The possibility that Sr2+ is also an exacerbating factor in MN pathogenesis is reasonable. Full-Text PDF Traditional indigenous medicines are an etiologic consideration for NELL1-positive membranous nephropathyKidney InternationalVol. 102Issue 6PreviewTraditional indigenous medicines (TIM) are founded on ancient historical practice. These medications are obtained over the counter, vary in composition, and contain heavy metals. Their use may not be documented within medical records, and therefore, toxicities of TIM are highly under-recognized. Full-Text PDF Open Access