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2018 ; 7
(1
): 55-61
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A case report of proliferative glomerulonephritis with monoclonal immunoglobulin
M-kappa deposits without associated lymphoproliferative disorder or detectable
paraproteinemia
#MMPMID29230710
Yamaguchi Y
; Maeda K
; Nagatoya K
; Yamauchi A
CEN Case Rep
2018[May]; 7
(1
): 55-61
PMID29230710
show ga
A 53-year-old man presented with proteinuria and hematuria. No significant
abnormality was detected in his physical examination or laboratory tests,
including evidence of paraprotein in serum and urine. Renal biopsy revealed
mesangial proliferation, thickened glomerular basement membranes, and spike
formation. Immunofluorescence revealed deposition of immunoglobulin (Ig) M heavy
chain, kappa (?) light chain, and complement component C3 along capillary walls
in the glomeruli. Light chain staining indicated significant restriction, because
only ? chain, not lambda chain, was present in glomeruli. Aggregated electron
dense deposits were observed in the subepithelial area and within the lamina
densa on electron-microscopic examination. Cryoglobulinemia and amyloidosis were
ruled out. Clinically, steroid therapy was not initiated due to patient
preference, and the only prescribed medication was an angiotensin II receptor
blocker. At the approximately 3-year follow-up, estimated glomerular filtration
rate had decreased very mildly. The present case demonstrates that deposition of
monoclonal IgM-? may be associated with membranoproliferative
glomerulonephritis-like changes in the glomeruli. Although no underlying
hematological abnormality or paraproteinemia was observed in this case within the
range of limited clinical examination, the patient's condition is consistent with
proliferative glomerulonephritis with monoclonal IgM deposits, similar to the
recently established proliferative glomerulonephritis with monoclonal IgG
deposits. Further elucidation of the pathophysiology and effective treatments of
the disorder should be expected in the future through the accumulation of similar
cases.