Proliferative glomerulonephritis with monoclonal IgG deposits

Samih H. Nasr, Anjali Satoskar, Glen S. Markowitz, Anthony M. Valeri, Gerald B. Appel, Michael B. Stokes, Tibor Nadasdy, Vivette D. D'Agati

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Abstract

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 IgG3κ(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.

Original languageEnglish (US)
Pages (from-to)2055-2064
Number of pages10
JournalJournal of the American Society of Nephrology
Volume20
Issue number9
DOIs
StatePublished - Sep 1 2009

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ASJC Scopus subject areas

  • Nephrology

Cite this

Nasr, S. H., Satoskar, A., Markowitz, G. S., Valeri, A. M., Appel, G. B., Stokes, M. B., Nadasdy, T., & D'Agati, V. D. (2009). Proliferative glomerulonephritis with monoclonal IgG deposits. Journal of the American Society of Nephrology, 20(9), 2055-2064. https://doi.org/10.1681/ASN.2009010110