Tags

Type your tag names separated by a space and hit enter

Successful treatment with bortezomib and dexamethasone for proliferative glomerulonephritis with monoclonal IgG deposits in multiple myeloma: a case report.
BMC Nephrol. 2017 04 06; 18(1):127.BN

Abstract

BACKGROUND

Proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) is a form of renal involvement by monoclonal IgG deposits that was found in mesangial, subendothelial or subepithelial regions. The distribution of glomerular deposits was completely different from that in monoclonal immunoglobulin deposition disease. PGNMID is reported to be rarely associated with a hematological malignancy. Previously, only five cases of PGNMID with multiple myeloma have been reported. However, the pathogenic relationship between PGNMID and multiple myeloma was unclear because a detailed description was not provided. We report that a patient with PGNMID associated with multiple myeloma was treated with bortezomib and dexamethasone and underwent the second renal biopsy after treatment, showing that chemotherapy was effective for PGNMID clinically and pathologically.

CASE PRESENTATION

A 75-year-old man presented with progressive leg edema, had nephrotic range proteinuria, hypoalbuminemia, moderate renal failure, and occult blood in his urine. Electrophoresis results showed serum and urinary monoclonal spikes of IgGκ type immunoglobulin. A renal biopsy specimen showed lobular mesangial proliferation with mesangiolysis, glomerular micro-aneurysm, and endocapillary hypercellularity. Immunofluorescence results revealed strong granular capillary and mesangial staining for IgG1, C3 and κ light chain in glomeruli without tubular deposits of any immunoglobulin. Electron microscopy also showed dense granular deposits in subendothelial and mesangial areas. PGNMID associated with multiple myeloma (IgGκ type) was diagnosed on the basis of a subsequent bone marrow examination. Bortezomib and dexamethasone therapy significantly reduced proteinuria and elevated serum albumin level. Eight months later, the second renal biopsy showed no active lesions and that the IgG1 and κ light chain deposits had drastically disappeared.

CONCLUSIONS

This is the first case of PGNMID with multiple myeloma successfully treated with bortezomib and dexamethasone in which comparative renal biopsies were performed before and after treatment. Our findings suggest the pathogenesis of PGNMID and therapeutic options for PGNMID.

Authors+Show Affiliations

Department of Clinical Nephrology, Kobe City Medical Center General Hospital, 2-1-1, Minatojimaminamimachi, Chuo-ku, Kobe-city, Hyogo, 650-0047, Japan.Department of Clinical Nephrology, Kobe City Medical Center General Hospital, 2-1-1, Minatojimaminamimachi, Chuo-ku, Kobe-city, Hyogo, 650-0047, Japan.Department of Clinical Hematology, Kobe City Medical Center General Hospital, Hyogo, Japan.Department of Clinical Hematology, Kobe City Medical Center General Hospital, Hyogo, Japan.Department of Diagnostic Pathology, Kobe University Hospital, Hyogo, Japan.Department of Nephrology, Kyoto University Graduate School of Medicine, Kyoto, Japan.Department of Clinical Nephrology, Kobe City Medical Center General Hospital, 2-1-1, Minatojimaminamimachi, Chuo-ku, Kobe-city, Hyogo, 650-0047, Japan. ayoshi@kcho.jp.Department of Nephrology, Kyoto University Graduate School of Medicine, Kyoto, Japan.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

28385149

Citation

Noto, Rio, et al. "Successful Treatment With Bortezomib and Dexamethasone for Proliferative Glomerulonephritis With Monoclonal IgG Deposits in Multiple Myeloma: a Case Report." BMC Nephrology, vol. 18, no. 1, 2017, p. 127.
Noto R, Kamiura N, Ono Y, et al. Successful treatment with bortezomib and dexamethasone for proliferative glomerulonephritis with monoclonal IgG deposits in multiple myeloma: a case report. BMC Nephrol. 2017;18(1):127.
Noto, R., Kamiura, N., Ono, Y., Tabata, S., Hara, S., Yokoi, H., Yoshimoto, A., & Yanagita, M. (2017). Successful treatment with bortezomib and dexamethasone for proliferative glomerulonephritis with monoclonal IgG deposits in multiple myeloma: a case report. BMC Nephrology, 18(1), 127. https://doi.org/10.1186/s12882-017-0524-7
Noto R, et al. Successful Treatment With Bortezomib and Dexamethasone for Proliferative Glomerulonephritis With Monoclonal IgG Deposits in Multiple Myeloma: a Case Report. BMC Nephrol. 2017 04 6;18(1):127. PubMed PMID: 28385149.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Successful treatment with bortezomib and dexamethasone for proliferative glomerulonephritis with monoclonal IgG deposits in multiple myeloma: a case report. AU - Noto,Rio, AU - Kamiura,Nozomu, AU - Ono,Yuichiro, AU - Tabata,Sumie, AU - Hara,Shigeo, AU - Yokoi,Hideki, AU - Yoshimoto,Akihiro, AU - Yanagita,Motoko, Y1 - 2017/04/06/ PY - 2015/12/08/received PY - 2017/03/23/accepted PY - 2017/4/8/entrez PY - 2017/4/8/pubmed PY - 2017/11/29/medline KW - Monoclonal gammopathy KW - Multiple myeloma KW - Proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) SP - 127 EP - 127 JF - BMC nephrology JO - BMC Nephrol VL - 18 IS - 1 N2 - BACKGROUND: Proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) is a form of renal involvement by monoclonal IgG deposits that was found in mesangial, subendothelial or subepithelial regions. The distribution of glomerular deposits was completely different from that in monoclonal immunoglobulin deposition disease. PGNMID is reported to be rarely associated with a hematological malignancy. Previously, only five cases of PGNMID with multiple myeloma have been reported. However, the pathogenic relationship between PGNMID and multiple myeloma was unclear because a detailed description was not provided. We report that a patient with PGNMID associated with multiple myeloma was treated with bortezomib and dexamethasone and underwent the second renal biopsy after treatment, showing that chemotherapy was effective for PGNMID clinically and pathologically. CASE PRESENTATION: A 75-year-old man presented with progressive leg edema, had nephrotic range proteinuria, hypoalbuminemia, moderate renal failure, and occult blood in his urine. Electrophoresis results showed serum and urinary monoclonal spikes of IgGκ type immunoglobulin. A renal biopsy specimen showed lobular mesangial proliferation with mesangiolysis, glomerular micro-aneurysm, and endocapillary hypercellularity. Immunofluorescence results revealed strong granular capillary and mesangial staining for IgG1, C3 and κ light chain in glomeruli without tubular deposits of any immunoglobulin. Electron microscopy also showed dense granular deposits in subendothelial and mesangial areas. PGNMID associated with multiple myeloma (IgGκ type) was diagnosed on the basis of a subsequent bone marrow examination. Bortezomib and dexamethasone therapy significantly reduced proteinuria and elevated serum albumin level. Eight months later, the second renal biopsy showed no active lesions and that the IgG1 and κ light chain deposits had drastically disappeared. CONCLUSIONS: This is the first case of PGNMID with multiple myeloma successfully treated with bortezomib and dexamethasone in which comparative renal biopsies were performed before and after treatment. Our findings suggest the pathogenesis of PGNMID and therapeutic options for PGNMID. SN - 1471-2369 UR - https://www.unboundmedicine.com/medline/citation/28385149/Successful_treatment_with_bortezomib_and_dexamethasone_for_proliferative_glomerulonephritis_with_monoclonal_IgG_deposits_in_multiple_myeloma:_a_case_report_ L2 - https://www.biomedcentral.com/1471-2369/18/127 DB - PRIME DP - Unbound Medicine ER -