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2013 ; 2
(2
): 197-203
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Proliferative glomerulonephritis with monoclonal IgG2? deposit successfully
treated with steroids: a case report and review of the literature
#MMPMID28509293
Ohashi R
; Sakai Y
; Otsuka T
; Ohno D
; Masuda Y
; Murasawa T
; Sato N
; Shimizu A
CEN Case Rep
2013[Nov]; 2
(2
): 197-203
PMID28509293
show ga
A novel form of glomerular injury with monoclonal immunoglobulin (Ig) IgG
deposition, termed "proliferative glomerulonephritis (GN) with monoclonal IgG
deposits" (PGNMID), is a recently described entity. PGNMID presents with various
histological patterns, such as membranoproliferative GN, endocapillary
proliferative GN and membranous nephropathy (MN). The deposits are composed of
monoclonal immunoglobulin, most commonly IgG3 and occasionally IgG2. At present,
the clinical significance of each IgG subclass and the morphological patterns of
glomerular injury have not been fully investigated due to the limited number of
PGNMID cases reported. The patient was a 27-year-old woman presenting with a mild
degree of proteinuria and no other physical or serological abnormalities.
Monoclonal Ig could not be identified in her serum or urine. Renal biopsy found
features of MN with deposition of monoclonal IgG2?. Electron microscopy
examination revealed non-organised electron-dense deposits predominantly in
subepithelial locations. Based on a diagnosis of PGNMID, she was treated with
prednisolone and proteinuria significantly decreased in less than 4 weeks.
Although the clinical outcomes of PGNMID remain to be defined, MN features may
possibly be a sign of favourable prognosis-a hypothesis supported by recent
reports. The absence of advanced chronic damage in the kidney, such as
glomerulosclerosis or tubulointerstitial fibrosis, may also have contributed to
the favourable outcome in the present case. Further studies on additional PGNMID
cases that allow the correlation of morphological features and IgG subclasses
with clinical outcomes are needed in order to confirm our findings and further
solidify the clinical aspects of this new disease entity.