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Updated: Dec 22, 2025
Analyses of Proteinuria, Renal Infiltration of Leukocytes, and Renal Deposition of Proteins in Lupus-prone MRL/lpr Mice
Published on: June 8, 2022
A case of proliferative glomerulonephritis with immunoglobulin A1-lambda deposits successfully treated by
Yasuo Kusunoki1, Tomoko Namba-Hamano2, Tsunayuki Kakimoto3
1Division of Nephrology, Department of Internal Medicine, Toyonaka Municipal Hospital, 4-14-1, Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan.
Insights
This study details a successful chemotherapy treatment for a patient with proliferative glomerulonephritis with monoclonal immunoglobulin deposits. Elotuzumab-based therapy improved kidney function in this rare case.
Area of Science:
- Nephrology
- Hematology
- Oncology
Background:
- Monoclonal gammopathies can lead to kidney damage, including proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID).
- Effective treatments for PGNMID remain challenging, often requiring tailored approaches based on the underlying plasma cell dyscrasia.
Observation:
- A 74-year-old male presented with nephrotic syndrome and kidney insufficiency, diagnosed with immunoglobulin A-lambda monoclonal gammopathy and multiple myeloma.
- Renal biopsy showed diffuse mesangial proliferation and characteristic immunoglobulin A and C3 deposition, confirming PGNMID.
Findings:
- Initial chemotherapy with bortezomib and dexamethasone was ineffective.
- Subsequent treatment with elotuzumab, lenalidomide, and dexamethasone led to successful recovery of kidney function.
Implications:
- This case highlights the potential efficacy of elotuzumab-containing chemotherapy for PGNMID associated with multiple myeloma.
- Successful treatment of PGNMID with novel agents like elotuzumab offers a new therapeutic avenue for patients with this rare kidney disease.
Abstract:
A 74-year-old man presented with nephrotic syndrome and kidney insufficiency. Laboratory tests revealed monoclonal gammopathy of immunoglobulin A-lambda. Renal biopsy revealed diffuse mesangial proliferation and double-contoured basement membranes. Immunofluorescent analyses showed granular deposition of immunoglobulin A and C3 at the capillary walls and mesangial regions. Immunohistochemistry suggested monoclonal deposition of immunoglobulin A1-lambda. Electron microscopic analyses showed finely granular electron-dense deposits at mesangial and subendothelial areas. These findings suggested immunoglobulin A-type proliferative glomerulonephritis with monoclonal immunoglobulin deposits. Based on the results of bone marrow aspiration, multiple myeloma was diagnosed. Because the renal manifestation was considered to be affected by monoclonal gammopathy, chemotherapy was initiated rather than immunomodulatory therapy. Although bortezomib and dexamethasone proved ineffective, second chemotherapy with elotuzumab, lenalidomide, and dexamethasone was successful, and kidney function recovered. Effective treatments for proliferative glomerulonephritis with monoclonal immunoglobulin deposits have not been established. This represents the first description of a patient successfully treated for proliferative glomerulonephritis with monoclonal immunoglobulin deposits by chemotherapy using elotuzumab.
