title: Filgrastim-Induced Crescentic Transformation of Recurrent IgG2λ GN.
abstract: Proliferative GN with monoclonal IgG deposits is an increasingly recognized form of GN, but its relation to hematologic malignancy remains poorly understood. Filgrastim, an analog for granulocyte colony-stimulating factor produced by recombinant DNA technology, is frequently used to stimulate bone marrow release of hematopoietic progenitor cells in preparation for stem cell transplant. We report an exceptional case of proliferative GN with monoclonal IgG2λ deposits in a young man whose disease progressed slowly to CKD, which was followed by a preemptive kidney transplant. The patient developed recurrent GN in the allograft and clinically detectable plasma cell neoplasm 9 years after the first renal manifestations. Contemporaneous with filgrastim administration for stem cell mobilization, the patient's slowly progressive GN underwent severe crescentic transformation, leading to rapidly progressive and irreversible allograft failure. This report explores the spectrum of GN with monoclonal IgG deposits and the pathophysiologic role of granulocyte colony-stimulating factor in exacerbation of preexisting GN.
authors.affiliation: Renal Pathology, Department of Pathology and Cell Biology, ib2349@columbia.edu.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Batal
authors.affiliation: Renal Pathology, Department of Pathology and Cell Biology.
authors.forename: Glen S
authors.initials: GS
authors.lastname: Markowitz
authors.affiliation: Nephrology, Department of Medicine, and.
authors.forename: Waichi
authors.initials: W
authors.lastname: Wong
authors.affiliation: Nephrology, Department of Medicine, and.
authors.forename: Rupali
authors.initials: R
authors.lastname: Avasare
authors.affiliation: Division of Hematology/Oncology and Columbia Center for Translational Immunology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Markus Y
authors.initials: MY
authors.lastname: Mapara
authors.affiliation: Nephrology, Department of Medicine, and.
authors.forename: Gerald B
authors.initials: GB
authors.lastname: Appel
authors.affiliation: Renal Pathology, Department of Pathology and Cell Biology.
authors.forename: Vivette D
authors.initials: VD
authors.lastname: D'Agati
mesh_terms: D000328:Adult; D000069585:Filgrastim / Q000009:adverse effects*; D015432:Glomerulonephritis, Membranoproliferative / Q000139:chemically induced* / Q000473:pathology*; D006801:Humans; D007074:Immunoglobulin G; D016030:Kidney Transplantation; D008297:Male; D011183:Postoperative Complications / Q000139:chemically induced* / Q000473:pathology*; D012008:Recurrence
chemical_list: D007074:Immunoglobulin G; D000069585:Filgrastim
keywords: glomerulonephritis; kidney biopsy; paraprotein