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J Nephropathol. 2017;6(3): 220-224.
doi: 10.15171/jnp.2017.36
PMID: 28975104
PMCID: PMC5607986
Scopus ID: 85019940883
  Abstract View: 4043
  PDF Download: 2565

Case Report

Proliferative glomerulonephritis with monoclonal IgG deposits; an unusual cause of de novo disease in kidney allograft

Sabiha M Hussain, Kalathil K Sureshkumar*

1 Division of Nephrology and Hypertension, Department of Medicine, Allegheny General Hospital, Pittsburgh, USA
*Corresponding Author: *Corresponding author: Kalathil K Sureshkumar, , Email: ksureshk@wpahs.org

Abstract

Background: Proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) is
a newly described and rare entity that can develop in native and very rarely in transplanted
kidneys. We present a patient who developed de novo PGNMID in the kidney allograft
along with a review of the literature.

Case Presentation: A 38-year old female with type 1 diabetes who underwent successful
simultaneous pancreas-kidney (SPK) transplantation 6 years earlier presented with rising
serum creatinine, nephrotic range proteinuria and microhematuria. She underwent
extensive work up and kidney allograft biopsy revealed mesangial expansion and
hypercelluarity on light microscopy, mesangial staining for IgG3, kappa light chains, C1q
and C3 on immunofluorescence and abundant mesangial electron dense deposits without
substructures on electron microscopy. Serum and urine immunofixation electrophoresis
were negative. A diagnosis of de novo PGNMID was made. Patient’s proteinuria improved
and serum creatinine stabilized with conservative therapy.

Conclusions: PGNMID can rarely develop in kidney allograft as recurrent or de novo disease
and may be mislabeled as transplant glomerulopathy if careful immunofluorescence and
electron microscopy are not performed on biopsy specimens. Further studies are needed
to better understand the pathogenesis of this disease entity and to develop optimal
therapeutic approaches.


Implication for health policy/practice/research/medical education:

 
Proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) can develop in kidney allografts as a recurrent
disease and very rarely as de novo. A high index of suspicion is needed to make the diagnosis. PGNMID can be mistakenly
labeled as transplant glomerulopathy if immunofluorescence and electron microscopy are not performed on the allograft
biopsy with light microscopy showing changes of membrano-proliferative glomerulonephritis (MPGN). Further studies are
needed to better understand the pathogenesis of this disease entity and to develop optimal therapeutic strategies.
Please cite this paper as: 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. DOI: 10.15171/jnp.2017.36.

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Submitted: 03 Jan 2017
Accepted: 20 Mar 2017
ePublished: 05 Apr 2017
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