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Patterns of noncryoglobulinemic glomerulonephritis with monoclonal Ig deposits: correlation with IgG subclass and response to rituximab.
Clin J Am Soc Nephrol. 2011 Jul; 6(7):1609-16.CJ

Abstract

BACKGROUND AND OBJECTIVES

Several different entities have recently been described among glomerular diseases associated with monoclonal IgG deposits. The aim of this study was to describe the distribution of the different pathologic subtypes of IgG-associated glomerulopathy and to evaluate the IgG isotype involved in these diseases.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

This was a retrospective study including all patients with glomerular deposits of monoclonal IgG referred to three nephrology departments between 1980 and 2008.

RESULTS

Twenty-six patients were included. Nephrotic syndrome was almost constantly associated with a renal dysfunction in 14 of 26 patients. The presence of M-spike was detected in only 30% of the patients, and an overt hematologic malignancy (myeloma, lymphoma) was identified in 9 of 26 patients. Patients were almost equally divided into two distinct histologic patterns: membranous nephropathy (MN) or membranoproliferative glomerulonephritis (MPGN). IgG3 deposits were identified in 80% of patients with MPGN, whereas IgG1 deposits were present in 64% of patients with MN. Ultrastructural study showed that immune deposits were nonorganized in most patients. Seven patients were treated with rituximab with excellent results: five of seven had a complete remission of the nephrotic syndrome and two of seven had a partial response. After a mean 24-month follow-up, only one patient experienced relapse of the nephropathy.

CONCLUSIONS

GN with monoclonal Ig deposits can be associated with MPGN or MN, which are correlated with IgG3 and IgG1 isotypes, respectively. Rituximab appears to have a very favorable benefit-to-risk ratio for patients with no overt hematologic malignancy.

Authors+Show Affiliations

Department Nephrology, Hôpital Européen Georges Pompidou, Paris, France.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

21700823

Citation

Guiard, Elsa, et al. "Patterns of Noncryoglobulinemic Glomerulonephritis With Monoclonal Ig Deposits: Correlation With IgG Subclass and Response to Rituximab." Clinical Journal of the American Society of Nephrology : CJASN, vol. 6, no. 7, 2011, pp. 1609-16.
Guiard E, Karras A, Plaisier E, et al. Patterns of noncryoglobulinemic glomerulonephritis with monoclonal Ig deposits: correlation with IgG subclass and response to rituximab. Clin J Am Soc Nephrol. 2011;6(7):1609-16.
Guiard, E., Karras, A., Plaisier, E., Duong Van Huyen, J. P., Fakhouri, F., Rougier, J. P., Noel, L. H., Callard, P., Delahousse, M., & Ronco, P. (2011). Patterns of noncryoglobulinemic glomerulonephritis with monoclonal Ig deposits: correlation with IgG subclass and response to rituximab. Clinical Journal of the American Society of Nephrology : CJASN, 6(7), 1609-16. https://doi.org/10.2215/CJN.10611110
Guiard E, et al. Patterns of Noncryoglobulinemic Glomerulonephritis With Monoclonal Ig Deposits: Correlation With IgG Subclass and Response to Rituximab. Clin J Am Soc Nephrol. 2011;6(7):1609-16. PubMed PMID: 21700823.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Patterns of noncryoglobulinemic glomerulonephritis with monoclonal Ig deposits: correlation with IgG subclass and response to rituximab. AU - Guiard,Elsa, AU - Karras,Alexandre, AU - Plaisier,Emmanuelle, AU - Duong Van Huyen,Jean-Paul, AU - Fakhouri,Fadi, AU - Rougier,Jean-Philippe, AU - Noel,Laure-Hélène, AU - Callard,Patrice, AU - Delahousse,Michel, AU - Ronco,Pierre, Y1 - 2011/06/23/ PY - 2011/6/25/entrez PY - 2011/6/28/pubmed PY - 2011/11/9/medline SP - 1609 EP - 16 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 6 IS - 7 N2 - BACKGROUND AND OBJECTIVES: Several different entities have recently been described among glomerular diseases associated with monoclonal IgG deposits. The aim of this study was to describe the distribution of the different pathologic subtypes of IgG-associated glomerulopathy and to evaluate the IgG isotype involved in these diseases. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a retrospective study including all patients with glomerular deposits of monoclonal IgG referred to three nephrology departments between 1980 and 2008. RESULTS: Twenty-six patients were included. Nephrotic syndrome was almost constantly associated with a renal dysfunction in 14 of 26 patients. The presence of M-spike was detected in only 30% of the patients, and an overt hematologic malignancy (myeloma, lymphoma) was identified in 9 of 26 patients. Patients were almost equally divided into two distinct histologic patterns: membranous nephropathy (MN) or membranoproliferative glomerulonephritis (MPGN). IgG3 deposits were identified in 80% of patients with MPGN, whereas IgG1 deposits were present in 64% of patients with MN. Ultrastructural study showed that immune deposits were nonorganized in most patients. Seven patients were treated with rituximab with excellent results: five of seven had a complete remission of the nephrotic syndrome and two of seven had a partial response. After a mean 24-month follow-up, only one patient experienced relapse of the nephropathy. CONCLUSIONS: GN with monoclonal Ig deposits can be associated with MPGN or MN, which are correlated with IgG3 and IgG1 isotypes, respectively. Rituximab appears to have a very favorable benefit-to-risk ratio for patients with no overt hematologic malignancy. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/21700823/Patterns_of_noncryoglobulinemic_glomerulonephritis_with_monoclonal_Ig_deposits:_correlation_with_IgG_subclass_and_response_to_rituximab_ L2 - http://cjasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=21700823 DB - PRIME DP - Unbound Medicine ER -