isrtpcon 2013 lt col rohit tewari dept of pathology armed forces medical college pune
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ISRTPCON 2013
Lt Col Rohit TewariDept of PathologyArmed Forces Medical CollegePune
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Age- 55 yrsSex- MaleKnown hypertensive and diabetic (5 yrs)Presented with rapid deterioration of
renal functionS Cr 1.6 mg% to 7.5 mg% over 4
months. Urine examination-
◦Alb 2+◦8-10 pus cells◦25-30 RBC
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S-9077-10
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IgG IgG
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C3 C1Q
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Kappa Lambda
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Proliferative Glomerulonephritis, Suggestion of Lupus nephritis
All serological tests done subsequently for SLE- Neg
Renal function progressively worsened over the next one and a half year.
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Taken up for Live unrelated renal allograft transplant, standard immunosuppression.
Immediate post transplant period – uneventful.
Baseline S Cr 1.1-1.2
Brain abscess after 2 months. Mycophenolate stopped.
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S Cr 2.3 gm%.Acute graft rejection suspected.
Biopsy
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S-11235-12
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IgG
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C3 C1Q
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Kappa Lambda
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IgG1 IgG2
IgG3 IgG4
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Proliferative glomerulonephritis with monoclonal immunoglobulin deposits. (PGNMID)
Work up for myeloma- initially neg, 2 mths later- M band
Recurrent or denovo?
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kappa Lambda
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IgG1 IgG2
iIgG3 IgG4
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FINAL DIAGNOSIS◦Proliferative glomerulonephritis with
monoclonal immunoglobulin deposits.
◦Recurrence in renal allograft.Follow upAutologous Stem cell transplantDoing well
reduction in proteinuria
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.Kidney International, Vol. 65 (2004), pp. 85–96Proliferative glomerulonephritis with monoclonal IgG deposits:A distinct entity mimicking immune-complex glomerulonephritisSAMIH H. NASR, GLEN S. MARKOWITZ, M. BARRY STOKES, SURYA V. SESHAN, ELSA VALDERRAMA,GERALD B. APPEL, PIERRE AUCOUTURIER, and VIVETTE D. D’AGATIDepartment of Pathology and Department of Medicine, Columbia University, College of Physicians and Surgeons, New York,New York; Department of Pathology, Weill Medical College of Cornell University, New York, New York; Department of Pathology,
Ten cases described.
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Proteinuria in 100%Renal insufficiency in 80%Microhematuria in 60%Monoclonal serum/urinary protein
identified in 50%None had evidence of a
myeloma/ B cell lymphoproliferative disorder
No data on outcome/followup
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NDT Plus (2010) 3: 357–359doi: 10.1093/ndtplus/sfq076Advance Access publication 2 May 2010Case ReportSteroid-responsive nephrotic syndrome in a patient with proliferativeglomerulonephritis with monoclonal IgG deposits with pure mesangialproliferative featuresAtsushi
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One patient who had denovo disease in the allograft
One patient had recurrent disease 1 yr after transplant
1503 Proliferative Glomerulonephritis with Monoclonal IgG DepositsRecurs or May Develop De Novo in Renal AllograftsA Albawardi, A Satoskar, S Brodsky, GM Nadasdy, T Nadasdy. The Ohio State University,
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Why this case is presented?Rarity of the conditionEarly recurrence in the renal
allograft Importance of routinely
performing kappa and lambda in renal biopsy.
Possibility of initial negativity of myeloma workup.
Recognizing and interpreting linear accentuation in diabetes.