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Proliferative glomerulonephritis with monoclonal immunoglobulin deposition disease: The utility of routine staining with immunoglobulin light chains.

Gowda KK, Nada R, Ramachandran R, Joshi K, Tewari R, Kohli HS, Jha V, Gupta KL - Indian J Nephrol (2015 Nov-Dec)

Bottom Line: None of these patients had overt multiple myeloma.The predominant histologic pattern was membranoproliferative with all the biopsies showing IgG3 Kappa deposits on IF.The deposits were primarily subendothelial on electron microscopy.

View Article: PubMed Central - PubMed

Affiliation: Department of Histopathology, PGIMER, Chandigarh, India.

ABSTRACT
Proliferative glomerulonephritis occurring as a consequence of monoclonal glomerular deposits of IgG is uncommon. It is a form of renal involvement in monoclonal gammopathy that mimics immune complex glomerulonephritis. Here, we report the first series of proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) from the Indian subcontinent highlighting use of light chain immunofluorescence (IF) in routine renal biopsy interpretation. We retrieved 6 patients diagnosed as proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) out of 160 biopsies (3.7%) with membranoproliferative patterns over 5 1/2 years (2009-2014), one of whom had recurrence 6 months post-renal transplant. Four (67%) patients presented with rapidly progressive renal failure and two (33%) with nephrotic syndrome. None of these patients had overt multiple myeloma. The predominant histologic pattern was membranoproliferative with all the biopsies showing IgG3 Kappa deposits on IF. The deposits were primarily subendothelial on electron microscopy.

No MeSH data available.


Related in: MedlinePlus

Electron microscopy (case 3) showed subendothelial electron dense deposits with effacement of foot processes of podocytes (Uranyl acetate, ×17,100)
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Figure 3: Electron microscopy (case 3) showed subendothelial electron dense deposits with effacement of foot processes of podocytes (Uranyl acetate, ×17,100)

Mentions: Glomeruli showed granular staining for IgG and C3 along glomerular capillary loops and focally in mesangium with light chain restriction (kappa restricted in 6 cases) by direct IF. IF for IgG subtypes demonstrated presence of IgG3 alone in all the 6 cases [Figure 2]. EM confirmed presence of subendothelial deposits with effacement of foot process [Figure 3]. Some deposits in mesangial regions were seen in all cases [Figure 3]. Absence of Randall type of deposits excluded monoclonal immunoglobulin deposition disease (light/heavy chain) and absence of organized deposits excluded cryoglobulinemic glomerulonephritis and immunotactoid glomerulonephritis.


Proliferative glomerulonephritis with monoclonal immunoglobulin deposition disease: The utility of routine staining with immunoglobulin light chains.

Gowda KK, Nada R, Ramachandran R, Joshi K, Tewari R, Kohli HS, Jha V, Gupta KL - Indian J Nephrol (2015 Nov-Dec)

Electron microscopy (case 3) showed subendothelial electron dense deposits with effacement of foot processes of podocytes (Uranyl acetate, ×17,100)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663771&req=5

Figure 3: Electron microscopy (case 3) showed subendothelial electron dense deposits with effacement of foot processes of podocytes (Uranyl acetate, ×17,100)
Mentions: Glomeruli showed granular staining for IgG and C3 along glomerular capillary loops and focally in mesangium with light chain restriction (kappa restricted in 6 cases) by direct IF. IF for IgG subtypes demonstrated presence of IgG3 alone in all the 6 cases [Figure 2]. EM confirmed presence of subendothelial deposits with effacement of foot process [Figure 3]. Some deposits in mesangial regions were seen in all cases [Figure 3]. Absence of Randall type of deposits excluded monoclonal immunoglobulin deposition disease (light/heavy chain) and absence of organized deposits excluded cryoglobulinemic glomerulonephritis and immunotactoid glomerulonephritis.

Bottom Line: None of these patients had overt multiple myeloma.The predominant histologic pattern was membranoproliferative with all the biopsies showing IgG3 Kappa deposits on IF.The deposits were primarily subendothelial on electron microscopy.

View Article: PubMed Central - PubMed

Affiliation: Department of Histopathology, PGIMER, Chandigarh, India.

ABSTRACT
Proliferative glomerulonephritis occurring as a consequence of monoclonal glomerular deposits of IgG is uncommon. It is a form of renal involvement in monoclonal gammopathy that mimics immune complex glomerulonephritis. Here, we report the first series of proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) from the Indian subcontinent highlighting use of light chain immunofluorescence (IF) in routine renal biopsy interpretation. We retrieved 6 patients diagnosed as proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) out of 160 biopsies (3.7%) with membranoproliferative patterns over 5 1/2 years (2009-2014), one of whom had recurrence 6 months post-renal transplant. Four (67%) patients presented with rapidly progressive renal failure and two (33%) with nephrotic syndrome. None of these patients had overt multiple myeloma. The predominant histologic pattern was membranoproliferative with all the biopsies showing IgG3 Kappa deposits on IF. The deposits were primarily subendothelial on electron microscopy.

No MeSH data available.


Related in: MedlinePlus