Abstract: This is a case of a 33⁃year⁃old female patient who was admitted to our hospital due to "abnormal urine test results detected for 20 years and massive proteinuria for 4 months". Twenty years ago, the patient was diagnosed with Wilson’s disease at another hospital based on abnormal neurological manifestations accompanied by mild proteinuria, and had received long⁃term penicillamine therapy for copper chelation. The current admission was prompted by a relapse of Wilson’s disease after self⁃discontinuation of copper⁃chelating medication for over a year. The renal injury presented with mild proteinuria as the initial manifestation, progressed gradually to nephrotic syndrome, and the serum creatinine level was within the normal range. Renal biopsy revealed membranous nephropathy, with immunofluorescence staining predominantly positive for IgG4, IgA, and C3, while antibodies associated with membranous nephropathy such as anti⁃PLA2R and anti⁃THSD7A were negative. Electron microscopy demonstrated extensive effacement of podocyte foot processes. A diagnosis of Wilson’s disease⁃associated membranous nephropathy was established. The patient achieved clinical remission of nephrotic syndrome following treatment with tacrolimus.

Key words: font-family:Inter, -apple-system, BlinkMacSystemFont, ", font-size:16px, background-color:#FFFFFF, ">Wilson disease、hepatolenticular degeneration、membranous nephropathy