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2016 ; 27
(7
): 1911-5
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Filgrastim-Induced Crescentic Transformation of Recurrent IgG2? GN
#MMPMID27147425
Batal I
; Markowitz GS
; Wong W
; Avasare R
; Mapara MY
; Appel GB
; D'Agati VD
J Am Soc Nephrol
2016[Jul]; 27
(7
): 1911-5
PMID27147425
show ga
Proliferative GN with monoclonal IgG deposits is an increasingly recognized form
of GN, but its relation to hematologic malignancy remains poorly understood.
Filgrastim, an analog for granulocyte colony-stimulating factor produced by
recombinant DNA technology, is frequently used to stimulate bone marrow release
of hematopoietic progenitor cells in preparation for stem cell transplant. We
report an exceptional case of proliferative GN with monoclonal IgG2? deposits in
a young man whose disease progressed slowly to CKD, which was followed by a
preemptive kidney transplant. The patient developed recurrent GN in the allograft
and clinically detectable plasma cell neoplasm 9 years after the first renal
manifestations. Contemporaneous with filgrastim administration for stem cell
mobilization, the patient's slowly progressive GN underwent severe crescentic
transformation, leading to rapidly progressive and irreversible allograft
failure. This report explores the spectrum of GN with monoclonal IgG deposits and
the pathophysiologic role of granulocyte colony-stimulating factor in
exacerbation of preexisting GN.