Recurrence of monoclonal gammopathy-related glomerulonephritis in renal allograft

A patient developed hematuria and nephrotic syndrome. A monoclonal IgG-lambda was detected in his serum, urine and glomeruli. Kidney biopsy revealed crescentic glomerulonephritis with characteristic "fibrils" or tactoids in the mesangial and subendothelial areas. Nine months after the diagnosis, he was placed on hemodialysis. Two years later, he received a cadaveric kidney transplantation. Eighteen months later, proteinuria recurred. Renal biopsy revealed crescentic glomerulonephritis, positive immunofluorescence for IgG-lambda and characteristic "fibrils" in the mesangium and subendothelium of the glomeruli. These findings were the same as those found in his native kidney. This finding demonstrates that glomerulonephritis associated with monoclonal gammopathy can recur in the allograft.