title: De novo proliferative glomerulonephritis with monoclonal IgG deposits of the IgG1κ subtype in a kidney allograft.
abstract: Proliferative glomerulonephritis with monoclonal immunoglobulin G (IgG) deposits (PGNMID) has recently been described in cases with glomerular disease. Only 16 cases of recurrent or de novo PGNMID have been reported in the transplanted kidney. Here we report a case of de novo PGNMID in a renal allograft diagnosed in the early stage by protocol biopsy. A 41-year-old male with end-stage kidney disease caused by focal glomerular sclerosis received a living-related kidney transplant. The post-transplantation course was stable, except for an early episode of acute T cell-mediated rejection. Mesangial C1q deposition was found on the 3-year protocol biopsy. On the 4-year protocol biopsy, mild mesangioproliferative changes and deposition of IgG, C1q, C3, IgG1, and κ light chain were evident, confirming the diagnosis of PGNMID of the IgG1κ subtype. Furthermore, mild proteinuria was detected at that time. Because a subsequent haematological examination revealed high copy number Epstein-Barr virus (EBV) DNA and free κ light chain in blood, the post-transplant lymphoproliferative disorder (PTLD) was suspected. Mycophenolate mofetil (MMF) was discontinued and rituximab was administered for the treatment of PTLD; subsequently, the improvement in proteinuria and serum creatinine was found 2 months after rituximab administration.
authors.affiliation: Department of Pathology, Sapporo City General Hospital.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Tsuji
authors.affiliation: Departments of Renal Transplant Surgery and Urology, Sapporo Hokuyu Hospital, Sapporo, Japan.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Miura
authors.affiliation: Department of Pathology, Sapporo City General Hospital.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Yanai
authors.affiliation: Department of Pathology, Sapporo City General Hospital.
authors.forename: Hiroe
authors.initials: H
authors.lastname: Itami
authors.affiliation: Department of Pathology, Sapporo City General Hospital.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Ishii
authors.affiliation: Department of Pathology, Sapporo City General Hospital.
authors.forename: Mayuko
authors.initials: M
authors.lastname: Akimoto
authors.affiliation: Department of Pathology, Sapporo City General Hospital.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Fukasawa
mesh_terms: D000328:Adult; D064591:Allografts; D000911:Antibodies, Monoclonal / Q000032:analysis*; D001706:Biopsy; D005455:Fluorescent Antibody Technique; D015432:Glomerulonephritis, Membranoproliferative / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis*; D007145:Immunoglobulin kappa-Chains / Q000032:analysis*; D007155:Immunologic Factors / Q000627:therapeutic use; D007678:Kidney Glomerulus / Q000187:drug effects / Q000276:immunology* / Q000648:ultrastructure; D016030:Kidney Transplantation / Q000009:adverse effects*; D008232:Lymphoproliferative Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology*; D008297:Male; D008854:Microscopy, Electron; D011507:Proteinuria / Q000209:etiology; D000069283:Rituximab / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D007074:Immunoglobulin G; D007145:Immunoglobulin kappa-Chains; D007155:Immunologic Factors; D000069283:Rituximab
keywords: de novo glomerulonephritis; post-transplant lymphoproliferative disorder; proliferative glomerulonephritis with monoclonal immunoglobulin G deposits; protocol biopsy; renal transplantation