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Proliferative glomerulonephritis with monoclonal IgM deposits without Waldenström's macroglobulinemia: case report and review of the literature.

Abstract

A 38-year-old man was presented with nephrotic syndrome associated with hematuria and mild hypocomplementemia. Renal biopsy revealed lobular mesangial proliferation, thickened capillary walls, and intraluminal protein thrombi. Immunofluorescence showed marked and mild depositions of immunoglobulin (Ig) M heavy chains and complement C3, respectively, in a peripheral lobular pattern. On light chain staining, only kappa (κ) light and IgM heavy chains showed a similar pattern. Electron microscopy showed fine granular electrondense deposits in subendothelial areas and numerous globular deposits (varying size and density) in glomerular capillary lumens. Serum levels of Ig κ, but not of free κ, light chains were significantly increased. Bone marrow aspiration revealed a normocellular marrow. Waldenström's macroglobulinemia and cryoglobulinemia were ruled out. Clinically, steroid therapy was ineffective and proteinuria persisted. This report demonstrates that glomerular deposition of monoclonal IgM-κ can produce membranoproliferative- like changes in the glomeruli. This condition may be recognized as proliferative glomerulonephritis with monoclonal IgM deposits similar to the recently recognized proliferative glomerulonephritis with monoclonal IgG deposits.

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  • Publisher Full Text
  • Authors

    Yahata M, Nakaya I, Takahashi S, Sakuma T, Sato H, Soma J

    Institution

    Departments of Nephrology, Iwate Prefectural Central Hospital Morioka, Iwate, Japan. myahata@chuo-hp.jp

    Source

    Clinical nephrology 77:3 2012 Mar pg 254-60

    MeSH

    Adult
    Antibodies, Monoclonal
    Biopsy
    Cell Proliferation
    Fluorescent Antibody Technique
    Glomerular Mesangium
    Glomerulonephritis, Membranoproliferative
    Hematuria
    Humans
    Immunoglobulin M
    Immunoglobulin kappa-Chains
    Male
    Microscopy, Electron
    Nephrotic Syndrome
    Predictive Value of Tests
    Waldenstrom Macroglobulinemia

    Pub Type(s)

    Case Reports
    Journal Article
    Review

    Language

    eng

    PubMed ID

    22377259