Proliferative Glomerulonephritis with Monoclonal IgG Deposits

被引:292
作者
Nasr, Samih H. [1 ]
Satoskar, Anjali [3 ]
Markowitz, Glen S. [1 ]
Valeri, Anthony M. [2 ]
Appel, Gerald B. [2 ]
Stokes, Michael B. [1 ]
Nadasdy, Tibor [3 ]
D'Agati, Vivette D. [1 ]
机构
[1] Columbia Univ, Dept Pathol, Coll Phys & Surg, New York, NY 10032 USA
[2] Columbia Univ, Div Nephrol, Coll Phys & Surg, New York, NY 10032 USA
[3] Ohio State Univ, Med Ctr, Dept Pathol, Columbus, OH 43210 USA
来源
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY | 2009年 / 20卷 / 09期
关键词
IMMUNOGLOBULIN DEPOSITION; DISEASE; FIBRILLARY; RITUXIMAB; DEPLETION;
D O I
10.1681/ASN.2009010110
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Dysproteinemias that result in monoclonal glomerular deposits of IgG are relatively uncommon. Here, we report the largest series of proliferative glomerulonephritis with monoclonal IgG deposits, a form of renal involvement by monoclonal gammopathy that mimics immune-complex glomerulonephritis. We retrospectively identified 37 patients, most of whom were white (81%), female (62%), or older than 50 yr (65%). At presentation, 49% had nephrotic syndrome, 68% had renal insufficiency, and 77% had hematuria. In 30% of the patients, we identified a monoclonal serum protein with the same heavy- and light-chain isotypes as the glomerular deposits (mostly IgG1 or IgG2), but only one patient had myeloma. Histologic patterns were predominantly membranoproliferative (57%) or endocapillary proliferative (35%) with membranous features. Electron microscopy revealed granular, nonorganized deposits, and immunofluorescence demonstrated glomerular deposits that stained for a single light-chain isotype and a single heavy-chain subtype, most commonly IgG3 kappa (53%). During an average of 30.3 mo of follow-up for 32 patients with available data, 38% had complete or partial recovery, 38% had persistent renal dysfunction, and 22% progressed to ESRD. Correlates of ESRD on univariate analysis were higher creatinine at biopsy, percentage of glomerulosclerosis, and degree of interstitial fibrosis but not immunomodulatory treatment or presence of a monoclonal spike. On multivariate analysis, higher percentage of glomerulosclerosis was the only independent predictor of ESRD. Only one patient lacking a monoclonal spike at presentation subsequently developed a monoclonal spike and no patient with a monoclonal spike at presentation subsequently developed a hematologic malignancy. We conclude that proliferative glomerulonephritis with monoclonal IgG deposits does not seem to be a precursor of myeloma in the vast majority of patients.
引用
收藏
页码:2055 / 2064
页数:10
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