Proliferative glomerulonephritis with monoclonal immunoglobulin G deposits is associated with high rate of early recurrence in the allograft

Samar M. Said, Fernando G Cosio, Anthony M. Valeri, Nelson Leung, Sanjeev M Sethi, Hassan Salameh, Lynn D. Cornell, Mary E. Fidler, Mariam P Alexander, Fernando Custodio Fervenza, Maria Eleni Drosou, Da Zhang, Vivette D. D'Agati, Samih H. Nasr

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

The characteristics of allograft proliferative glomerulonephritis with monoclonal immunoglobulin G deposits (PGNMID) are not well defined. To better characterize this disease we retrospectively identified 26 patients with allograft PGNMID, including 16 followed with early protocol biopsies. PGNMID was found to be a recurrent disease in most (89%) patients. A diagnostic biopsy was done for proteinuria and/or increased creatinine in most patients. Median time from transplant to diagnostic biopsy was 5.5 months, with detection within three to four months post-transplant in 86% of patients. Mesangial proliferative glomerulonephritis was the most common pattern on the diagnostic biopsy with 89% of cases showing immunoglobulin G3 subtype restriction. A detectable serum paraprotein was present in 20% of patients. During a mean follow up of 87 months from implantation, 11 of 25 patients lost their allograft largely due to PGNMID within a mean of 36 months from diagnosis. Median graft survival was 92 months. Independent predictors of graft loss were a higher degree of peak proteinuria and longer time from implantation to diagnosis. Sixteen patients were treated with immunosuppressive therapy which resulted in over 50% reduction in proteinuria in 60%, and improvement of glomerular pathology in nine of 13 patients. However, 44% of responders subsequently relapsed. Thus, PGNMID has a high recurrence rate in renal allografts occurring early with detection enhanced by protocol biopsies. Graft outcome is guarded as nearly half of patients lose their graft within three years from diagnosis. Hence, there is a need for better treatment strategies for this disease.

Original languageEnglish (US)
JournalKidney International
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Glomerulonephritis
Allografts
Immunoglobulin G
Recurrence
Transplants
Biopsy
Proteinuria
Paraproteins
Graft Survival
Immunosuppressive Agents
Immunoglobulins
Creatinine
Pathology
Kidney
Therapeutics
Serum

Keywords

  • membranoproliferative glomerulonephritis
  • monoclonal gammopathy
  • PGNMID
  • recurrent glomerulonephritis
  • renal allograft

ASJC Scopus subject areas

  • Nephrology

Cite this

Proliferative glomerulonephritis with monoclonal immunoglobulin G deposits is associated with high rate of early recurrence in the allograft. / Said, Samar M.; Cosio, Fernando G; Valeri, Anthony M.; Leung, Nelson; Sethi, Sanjeev M; Salameh, Hassan; Cornell, Lynn D.; Fidler, Mary E.; Alexander, Mariam P; Fervenza, Fernando Custodio; Drosou, Maria Eleni; Zhang, Da; D'Agati, Vivette D.; Nasr, Samih H.

In: Kidney International, 01.01.2018.

Research output: Contribution to journalArticle

Said, Samar M. ; Cosio, Fernando G ; Valeri, Anthony M. ; Leung, Nelson ; Sethi, Sanjeev M ; Salameh, Hassan ; Cornell, Lynn D. ; Fidler, Mary E. ; Alexander, Mariam P ; Fervenza, Fernando Custodio ; Drosou, Maria Eleni ; Zhang, Da ; D'Agati, Vivette D. ; Nasr, Samih H. / Proliferative glomerulonephritis with monoclonal immunoglobulin G deposits is associated with high rate of early recurrence in the allograft. In: Kidney International. 2018.
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abstract = "The characteristics of allograft proliferative glomerulonephritis with monoclonal immunoglobulin G deposits (PGNMID) are not well defined. To better characterize this disease we retrospectively identified 26 patients with allograft PGNMID, including 16 followed with early protocol biopsies. PGNMID was found to be a recurrent disease in most (89{\%}) patients. A diagnostic biopsy was done for proteinuria and/or increased creatinine in most patients. Median time from transplant to diagnostic biopsy was 5.5 months, with detection within three to four months post-transplant in 86{\%} of patients. Mesangial proliferative glomerulonephritis was the most common pattern on the diagnostic biopsy with 89{\%} of cases showing immunoglobulin G3 subtype restriction. A detectable serum paraprotein was present in 20{\%} of patients. During a mean follow up of 87 months from implantation, 11 of 25 patients lost their allograft largely due to PGNMID within a mean of 36 months from diagnosis. Median graft survival was 92 months. Independent predictors of graft loss were a higher degree of peak proteinuria and longer time from implantation to diagnosis. Sixteen patients were treated with immunosuppressive therapy which resulted in over 50{\%} reduction in proteinuria in 60{\%}, and improvement of glomerular pathology in nine of 13 patients. However, 44{\%} of responders subsequently relapsed. Thus, PGNMID has a high recurrence rate in renal allografts occurring early with detection enhanced by protocol biopsies. Graft outcome is guarded as nearly half of patients lose their graft within three years from diagnosis. Hence, there is a need for better treatment strategies for this disease.",
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AU - Said, Samar M.

AU - Cosio, Fernando G

AU - Valeri, Anthony M.

AU - Leung, Nelson

AU - Sethi, Sanjeev M

AU - Salameh, Hassan

AU - Cornell, Lynn D.

AU - Fidler, Mary E.

AU - Alexander, Mariam P

AU - Fervenza, Fernando Custodio

AU - Drosou, Maria Eleni

AU - Zhang, Da

AU - D'Agati, Vivette D.

AU - Nasr, Samih H.

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N2 - The characteristics of allograft proliferative glomerulonephritis with monoclonal immunoglobulin G deposits (PGNMID) are not well defined. To better characterize this disease we retrospectively identified 26 patients with allograft PGNMID, including 16 followed with early protocol biopsies. PGNMID was found to be a recurrent disease in most (89%) patients. A diagnostic biopsy was done for proteinuria and/or increased creatinine in most patients. Median time from transplant to diagnostic biopsy was 5.5 months, with detection within three to four months post-transplant in 86% of patients. Mesangial proliferative glomerulonephritis was the most common pattern on the diagnostic biopsy with 89% of cases showing immunoglobulin G3 subtype restriction. A detectable serum paraprotein was present in 20% of patients. During a mean follow up of 87 months from implantation, 11 of 25 patients lost their allograft largely due to PGNMID within a mean of 36 months from diagnosis. Median graft survival was 92 months. Independent predictors of graft loss were a higher degree of peak proteinuria and longer time from implantation to diagnosis. Sixteen patients were treated with immunosuppressive therapy which resulted in over 50% reduction in proteinuria in 60%, and improvement of glomerular pathology in nine of 13 patients. However, 44% of responders subsequently relapsed. Thus, PGNMID has a high recurrence rate in renal allografts occurring early with detection enhanced by protocol biopsies. Graft outcome is guarded as nearly half of patients lose their graft within three years from diagnosis. Hence, there is a need for better treatment strategies for this disease.

AB - The characteristics of allograft proliferative glomerulonephritis with monoclonal immunoglobulin G deposits (PGNMID) are not well defined. To better characterize this disease we retrospectively identified 26 patients with allograft PGNMID, including 16 followed with early protocol biopsies. PGNMID was found to be a recurrent disease in most (89%) patients. A diagnostic biopsy was done for proteinuria and/or increased creatinine in most patients. Median time from transplant to diagnostic biopsy was 5.5 months, with detection within three to four months post-transplant in 86% of patients. Mesangial proliferative glomerulonephritis was the most common pattern on the diagnostic biopsy with 89% of cases showing immunoglobulin G3 subtype restriction. A detectable serum paraprotein was present in 20% of patients. During a mean follow up of 87 months from implantation, 11 of 25 patients lost their allograft largely due to PGNMID within a mean of 36 months from diagnosis. Median graft survival was 92 months. Independent predictors of graft loss were a higher degree of peak proteinuria and longer time from implantation to diagnosis. Sixteen patients were treated with immunosuppressive therapy which resulted in over 50% reduction in proteinuria in 60%, and improvement of glomerular pathology in nine of 13 patients. However, 44% of responders subsequently relapsed. Thus, PGNMID has a high recurrence rate in renal allografts occurring early with detection enhanced by protocol biopsies. Graft outcome is guarded as nearly half of patients lose their graft within three years from diagnosis. Hence, there is a need for better treatment strategies for this disease.

KW - membranoproliferative glomerulonephritis

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KW - recurrent glomerulonephritis

KW - renal allograft

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