title: Proliferative glomerulonephritis with monoclonal immunoglobulin deposition disease: The utility of routine staining with immunoglobulin light chains.
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.
authors.affiliation: Department of Histopathology, PGIMER, Chandigarh, India.
authors.forename: K K
authors.initials: KK
authors.lastname: Gowda
authors.affiliation: Department of Histopathology, PGIMER, Chandigarh, India.
authors.forename: R
authors.initials: R
authors.lastname: Nada
authors.affiliation: Department of Nephrology, PGIMER, Chandigarh, India.
authors.forename: R
authors.initials: R
authors.lastname: Ramachandran
authors.affiliation: Department of Histopathology, PGIMER, Chandigarh, India.
authors.forename: K
authors.initials: K
authors.lastname: Joshi
authors.affiliation: Department of Histopathology, PGIMER, Chandigarh, India.
authors.forename: R
authors.initials: R
authors.lastname: Tewari
authors.affiliation: Department of Nephrology, PGIMER, Chandigarh, India.
authors.forename: H S
authors.initials: HS
authors.lastname: Kohli
authors.affiliation: Department of Nephrology, PGIMER, Chandigarh, India.
authors.forename: V
authors.initials: V
authors.lastname: Jha
authors.affiliation: Department of Nephrology, PGIMER, Chandigarh, India.
authors.forename: K L
authors.initials: KL
authors.lastname: Gupta
keywords: Kappa; lambda; monoclonal IgG; proliferative glomerulonephritis