Proliferative glomerulonephritis with monoclonal immunoglobulin G deposits complicated by immunoglobulin A nephropathy in the renal allograft

We describe a case of proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) combined with IgAN in a renal allograft. A‐21‐year‐old man developed end‐stage renal failure with unknown etiology and underwent living‐donor kidney transplantation from his mother 2 years after being diagnosed. One year after kidney transplantation, proteinuria 2+ and hematuria 2+ were detected; allograft biopsy revealed mesangial IgA and C3 deposits, indicating a diagnosis of IgAN. After tonsillectomy and steroid pulse therapy, proteinuria and hematuria resolved. However, 4 years after transplantation, pedal edema, proteinuria (6.89 g/day) and allograft dysfunction [serum creatinine (sCr) 203.3 µmol/L] appeared. A second allograft biopsy showed mesangial expansion and focal segmental proliferative endocapillary lesions with IgA1λ and monoclonal IgG1κ depositions. Electron microscopic analysis revealed massive amount of deposits, located in the mesangial and subendothelial lesions. A diagnosis of PGNMID complicated with IgAN was made, and rituximab and plasmapheresis were added to steroid pulse therapy. With this treatment, proteinuria was alleviated to 0.5 g/day, and the allograft dysfunction recovered to sCr 132.6 µmol/L. This case suggests a necessity for investigation of PGNMID and IgA nephropathy in renal allografts to detect monoclonal Ig deposition disease.

Source: Nephrology - March 12, 2016 Category: Urology & Nephrology Authors: Anri Sawada, Kunio Kawanishi, Shigeru Horita, Junki Koike, Kazuho Honda, Ayami Ochi, Mizuki Komoda, Yoichiro Tanaka, Kohei Unagami, Masayoshi Okumi, Tomokazu Shimizu, Hideki Ishida, Kazunari Tanabe, Yoji Nagashima, Kosaku Nitta Tags: Supplement Article Source Type: research