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Diagnosis: Membranoproliferative Glomerulonephritis with Monoclonal Deposits of IgG/kappa
Proliferative Glomerulonephritis with monoclonal IgG deposits (PGNMID) is a entity characterized by monoclonal IgG deposits in the kidney. The incidence of PGNMID in the native kidneys is about 0.17%. It can mimic other monoclonal diseases such as light and heavy chain deposition disease, light and heavy chain amyloid, immunotactoid and fibrillary glomerulonephritides and type I cryoglobulinemic glomerulonephritis. In PGNMID, monoclonal deposits are strictly glomerular consisting of single light chain isotype and single heavy chain subtype, most commonly IgG3 k. Membranoproliferative or endocapillary patterns of glomerulonephritis are seen on light microscopy with glomerular electron dense deposits on electron microscopy (Hussain SM, Sureshkumar KK. Proliferative glomerulonephritis with monoclonal IgG deposits; an unusual cause of de novo disease in kidney allograft. J Nephropathol. 2017;6:220-224. [PubMed link]).
In our patient, bone marrow studies domonstrated plasm cell neoplasm, and a diagnosis of multiple myeloma was made.
See the chapter: Membranoproliferative Glomerulonephritis of our Tutorial.
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References
- Hussain SM, Sureshkumar KK. Proliferative glomerulonephritis with monoclonal IgG deposits; an unusual cause of de novo disease in kidney allograft. J Nephropathol. 2017;6(3):220-224. [PubMed link].
- Lusco MA, Fogo AB, Najafian B, Alpers CE. AJKD Atlas of Renal Pathology: Proliferative Glomerulonephritis With Monoclonal Immunoglobulin Deposits. Am J Kidney Dis. 2016;67(3):e13-5. [PubMed link].
- Gowda KK, Nada R, Ramachandran R, Joshi K, Tewari R, Kohli HS, Jha V, Gupta KL. Proliferative glomerulonephritis with monoclonal immunoglobulin deposition disease: The utility of routine staining with immunoglobulin light chains. Indian J Nephrol. 2015;25(6):344-8. [PubMed link].
- Hamadah AM, Keddis MT, Cornell LD, Leung N. Proliferative glomerulonephritis due to monoclonal deposition with organized substructures. Am J Kidney Dis. 2014;64(6):994-8. [PubMed link].