Proliferative Glomerulonephritis in Monoclonal Gammopathy

Abstract

A 62-year-old white male suffering from plasmacytosis with monoclonal gammopathy developed gastrointestinal bleeding, microscopic hematuria, proteinuria and progressive azotemia. A renal biopsy demonstrated capillary wall thickening, mesangial hyperplasia, crescent formation and subepithelial humps. Serum immunoglobulin analysis showed IgG of lambda type. Serum complement, ANA, ASO titer and cryoglobulin were normal. It is suggested that proliferative glomerulonephritis with subepithelial humps should be added to forms of renal pathology that can be seen in plasma cell dyscrasias.

Proliferative glomerulonephritis with monoclonal IgG deposits: A distinct entity mimicking immune-complex glomerulonephritis

“…There have been other reports in the older literature of patients with proliferative glomerulonephritis associated with circulating monoclonal IgG, without associated cryoglobulin activity [13][14][15][16]. Because these reports lacked description of either electron microscopic or immunofluorescence examination or both, it is uncertain whether these cases represent Randall type monoclonal immunoglobulin deposition disease, immunotactoid glomerulopathy, or are similar to the cases reported herein.…”

Rapidly Progressive (‘Crescentic’) Glomerulonephritis and Monoclonal Gammapathies

“…The patient of Dharel al. [17], with lgG lambda myeloma, followed a similar, although more rapid course. More recently, Lapenas et al [18] reported on a patient with diabetes mellitus in whom rapidly progressive renal insufficiency revealed IgGkappa light chain myeloma and led to long-term hemodi alysis in 5 weeks.…”

Acute renal failure with polyarteritis nodosa and multiple myeloma

“…A nodular glomerulopathy with thickening of glomerular and tubular basement membranes and mesangial deposits of kappa light chains has been described (Randall et al, 1976;Seymour et al, 1980;Gallo et al, 1980;Knobler et al, 1983). Sometimes more severe mesangial (Avashti et al, 1977) or intraand extra-capillary cell proliferation with crescent formation occurs (Kaplan & Kaplan, 1970;Dhar et al, 1977;Silva et al, 1980). The myeloma may have been associated with polyarteritis by chance, but seems more likely to have copyright.…”