title: Proliferative glomerulonephritis due to monoclonal deposition with organized substructures.
abstract: A growing number of monoclonal gammopathy-associated kidney diseases recently have been recognized. We present the case of a 54-year-old man who presented with acute kidney injury and hypocomplementemia. Kidney biopsy confirmed the presence of immunoglobulin G κ pseudothrombi with intracytoplasmic crystals in glomeruli and tubules. Levels of κ free light chains were elevated without a detectable monoclonal gammopathy, and bone marrow biopsy results were normal. After the first course of rituximab, cyclophosphamide, and dexamethasone in addition to daily plasmapheresis, kidney function recovered within 2 weeks and dialysis therapy was discontinued. Treatment for monoclonal protein-induced kidney disease should be considered in the setting of progressive decreased kidney function, even in the absence of a circulating monoclonal protein or cellular clone of origin.
authors.affiliation: Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN. Electronic address: hamadah.abdurrahman@mayo.edu.
authors.forename: Abdurrahman M
authors.initials: AM
authors.lastname: Hamadah
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, Phoenix, AZ.
authors.forename: Mira T
authors.initials: MT
authors.lastname: Keddis
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
authors.forename: Lynn D
authors.initials: LD
authors.lastname: Cornell
authors.affiliation: Divisions of Hematology and Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Nelson
authors.initials: N
authors.lastname: Leung
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications* / Q000175:diagnosis*; D005500:Follow-Up Studies; D005921:Glomerulonephritis / Q000150:complications / Q000175:diagnosis; D015432:Glomerulonephritis, Membranoproliferative / Q000150:complications* / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged
keywords: Kidney failure; glomerulonephritis; monoclonal protein