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Proliferative glomerulonephritis with monoclonal IgG deposits
Samih H Nasr1, Anjali Satoskar, Glen S Markowitz
1Department of Pathology, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA. sn386@columbia.edu
Journal of the American Society of Nephrology : JASN
|May 28, 2009
Summary
Proliferative glomerulonephritis with monoclonal IgG deposits is a rare kidney disease mimicking immune-complex glomerulonephritis. Most patients do not progress to myeloma, with glomerulosclerosis predicting poor outcomes.
Area of Science:
- Nephrology
- Immunopathology
- Oncology
Background:
- Monoclonal immunoglobulin deposits in the glomeruli are uncommon.
- Proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) can mimic immune-complex glomerulonephritis.
- This study presents the largest series of PGNMID.
Purpose of the Study:
- To characterize the clinical, histologic, and outcome features of PGNMID.
- To identify predictors of renal outcomes in PGNMID.
- To assess the relationship between PGNMID and hematologic malignancies.
Main Methods:
- Retrospective analysis of 37 patients with PGNMID.
- Review of clinical presentation, renal biopsy findings (light microscopy, immunofluorescence, electron microscopy), and follow-up data.
- Statistical analysis to identify correlates of end-stage renal disease (ESRD).
Main Results:
- Most patients were older, white, and female, presenting with nephrotic syndrome, renal insufficiency, and hematuria.
- Histology predominantly showed membranoproliferative or endocapillary proliferative patterns with granular, nonorganized deposits.
- Glomerulosclerosis was the only independent predictor of ESRD; PGNMID was not a precursor to myeloma in most cases.
Conclusions:
- PGNMID is a distinct clinicopathologic entity with variable renal outcomes.
- Glomerulosclerosis is a key predictor of progression to ESRD.
- PGNMID is generally not associated with the subsequent development of hematologic malignancies.
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