{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T22:59:33Z","timestamp":1777503573771,"version":"3.51.4"},"reference-count":10,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Can J Kidney Health Dis"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Case Description:<\/jats:title>\n                    <jats:p>A 38-year-old man presented with NELL-1 positive membranous nephropathy (MN). Initial treatment with rituximab and later cyclosporine failed to result in sustained clinical improvement. Upon further review, the patient had been applying a skin fairness cream nightly for 2\u2009years preceding diagnosis. The cream was discontinued, and follow-up testing confirmed markedly elevated serum mercury levels of 66.8 \u00b5g\/L (normal less than 20 \u00b5g\/L), and 24-hour urine mercury of 103.9 nmol\/d. Two rounds of chelation therapy were arranged, the first with dimercaptosuccinic acid (DMSA) and the second with dimercaptopropane-1-sulfonic acid (DMPS) given cost and availability. Repeat mercury levels normalized but follow up kidney biopsy confirmed persistent immune complex glomerulonephritis. The patient was subsequently treated with prednisone followed by additional rituximab resulting in improvement of proteinuria and stabilization of kidney function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Rationale\/Teaching Points:<\/jats:title>\n                    <jats:p>This case reinforces the risk of mercury containing topicals and is the first to report systemic absorption of this magnitude. While chelation therapy is effective at improving systemic mercury levels, patients may require additional immunosuppression to treat immune complex-mediated MN following exposure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/20543581251376556","type":"journal-article","created":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T10:36:01Z","timestamp":1761906961000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Skin Fairness Cream\u2013Associated NELL-1 Membranous Nephropathy Treatment With Mercury Chelation and Immunosuppressive Therapy: An Educational Case Report"],"prefix":"10.1177","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-2968-0500","authenticated-orcid":false,"given":"Jordan","family":"Thorne","sequence":"first","affiliation":[{"name":"Division of Nephrology, Nova Scotia Health, Halifax, NS, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0371-9411","authenticated-orcid":false,"given":"Laura","family":"Berall","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Humber River Health, Toronto, ON, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laurette","family":"Geldenhuys","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Nova Scotia Health, Halifax, NS, Canada"},{"name":"Department of Pathology, Dalhousie University and Nova Scotia Health, Halifax, NS, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7919-6709","authenticated-orcid":false,"given":"Karthik","family":"Tennankore","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Nova Scotia Health, Halifax, NS, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,10,31]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2019.09.014"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfac237"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfy031"},{"key":"e_1_3_2_5_2","unstructured":"Fifth report on human biomonitoring of environmental chemicals in Canada: results of the Canadian Health Measures Survey cycle 5 (2016-2017) 2019. https:\/\/www.canada.ca\/en\/health-canada\/services\/environmental-workplace-health\/reports-publications\/environmental-contaminants\/fifth-report-human-biomonitoring.html"},{"key":"e_1_3_2_6_2","volume-title":"Testing for Blood Mercury Levels in the General Population","author":"Lambrinos A.","year":"2014","unstructured":"Lambrinos A. 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Toronto, ON, Canada: Health Quality Ontario; 2014."},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2024.03.025"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfae358"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/bs.ant.2021.01.001"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ekir.2022.03.009"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s13181-021-00848-1"}],"container-title":["Canadian Journal of Kidney Health and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20543581251376556","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/20543581251376556","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20543581251376556","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T15:22:03Z","timestamp":1777389723000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/20543581251376556"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10]]},"references-count":10,"alternative-id":["10.1177\/20543581251376556"],"URL":"https:\/\/doi.org\/10.1177\/20543581251376556","relation":{},"ISSN":["2054-3581","2054-3581"],"issn-type":[{"value":"2054-3581","type":"print"},{"value":"2054-3581","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10]]},"article-number":"20543581251376556"}}