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CEN Case Reports

, Volume 7, Issue 2, pp 320–324 | Cite as

Proliferative glomerulonephritis with unusual microlamellar organized deposits related to monoclonal immunoglobulin G3 (IgG3) kappa

  • Akiko Mii
  • Akira Shimizu
  • Daisuke Takada
  • Shuichi Tsuruoka
Case Report
  • 74 Downloads

Abstract

A 71-year-old woman presented with massive proteinuria and microhematuria. Renal biopsy showed diffuse global membranoproliferative and endocapillary proliferative lesions with leukocytic infiltration and an irregular duplication of the glomerular basement membrane on light microscopy. Immunofluorescence study showed granular deposits of monoclonal immunoglobulin G3 (IgG3) kappa, C3, and C1q in the glomeruli. Electron microscopy revealed unique structurally organized microlamellar electron-dense deposits. There was no evidence of systemic diseases such as paraproteinemia, cryoglobulinemia, or systemic lupus erythematosus. Following renal biopsy, the oral administration of mizoribine in addition to predonisolone gradually improved the patient’s clinical status. So far, partial remission has continued for a year, and she has not been affected with hematopoietic or lymphoproliferative disorders. We report a case of proliferative glomerulonephritis with unusual microlamellar organized deposits related to monoclonal IgG3 kappa. Our case was immunologically identical to proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID). Therefore, we concluded that our case should be categorized as an atypical form of PGNMID, though it was difficult to diagnose using the usual diagnostic approach to glomerular diseases with organized deposits.

Keywords

Proliferative glomerulonephritis Monoclonal IgG subclass restriction IgG3 kappa Microlamellar organized electron dense deposits 

Notes

Acknowledgements

We thank Dr. Masakazu Akashi (Department of Nephrology, Kita-Asaka station clinic, Saitama, Japan) for helpful comments and Ms. Arimi Ishikawa (Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan) for expert technical assistance.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Human and animal rights

All procedures performed in this case report were in accordance with the ethical standards of the institutional committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Written informed consent was obtained from the patient for publication of this case report and any accompanying images. This study does not contain any studies with animals performed by any of the authors.

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Copyright information

© Japanese Society of Nephrology 2018

Authors and Affiliations

  • Akiko Mii
    • 1
  • Akira Shimizu
    • 2
  • Daisuke Takada
    • 3
    • 4
  • Shuichi Tsuruoka
    • 1
  1. 1.Department of NephrologyNippon Medical SchoolTokyoJapan
  2. 2.Department of Analytic Human PathologyNippon Medical SchoolTokyoJapan
  3. 3.Department of NephrologyKita-Asaka Station ClinicSaitamaJapan
  4. 4.Department of NephrologyTama Nagayama Takada ClinicTokyoJapan

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