Skip to main content
SpringerLink
Log in

A case report of proliferative glomerulonephritis with monoclonal immunoglobulin M-kappa deposits without associated lymphoproliferative disorder or detectable paraproteinemia

  • Case Report
  • Published:
CEN Case Reports Aims and scope Submit manuscript

Abstract

A 53-year-old man presented with proteinuria and hematuria. No significant abnormality was detected in his physical examination or laboratory tests, including evidence of paraprotein in serum and urine. Renal biopsy revealed mesangial proliferation, thickened glomerular basement membranes, and spike formation. Immunofluorescence revealed deposition of immunoglobulin (Ig) M heavy chain, kappa (κ) light chain, and complement component C3 along capillary walls in the glomeruli. Light chain staining indicated significant restriction, because only κ chain, not lambda chain, was present in glomeruli. Aggregated electron dense deposits were observed in the subepithelial area and within the lamina densa on electron-microscopic examination. Cryoglobulinemia and amyloidosis were ruled out. Clinically, steroid therapy was not initiated due to patient preference, and the only prescribed medication was an angiotensin II receptor blocker. At the approximately 3-year follow-up, estimated glomerular filtration rate had decreased very mildly. The present case demonstrates that deposition of monoclonal IgM-κ may be associated with membranoproliferative glomerulonephritis-like changes in the glomeruli. Although no underlying hematological abnormality or paraproteinemia was observed in this case within the range of limited clinical examination, the patient’s condition is consistent with proliferative glomerulonephritis with monoclonal IgM deposits, similar to the recently established proliferative glomerulonephritis with monoclonal IgG deposits. Further elucidation of the pathophysiology and effective treatments of the disorder should be expected in the future through the accumulation of similar cases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Nasr SH, Satoskar A, Markowitz GS, Valeri AM, Appel GB, Stokes MB, Nadasdy T, D’Agati VD. Proliferative glomerulonephritis with monoclonal IgG deposits. J Am Soc Nephrol. 2009;20:2055–64.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Nasr SH, Markowitz GS, Stokes MB, Seshan SV, Valderrama E, Appel GB, Aucouturier P, D’Agati VD. Proliferative glomerulonephritis with monoclonal IgG deposits: a distinct entity mimicking immune-complex glomerulonephritis. Kidney Int. 2004;65:85–96.

    Article  CAS  PubMed  Google Scholar 

  3. Nasr SH, Valeri AM, Cornell LD, Fidler ME, Sethi S, D’Agati VD, Leung N. Renal monoclonal immunoglobulin deposition disease: a report of 64 patients from a single institution. Clin J Am Soc Nephrol. 2012;7:231–9.

    Article  PubMed  Google Scholar 

  4. Oe Y, Joh K, Sato M, Taguma Y, Onishi Y, Nakayama K, Sato T. Proliferative glomerulonephritis with monoclonal IgM-κ deposits in chronic lymphocytic leukemia/small lymphocytic leukemia: case report and review of the literature. CEN Case Reports. 2013;2:222–7.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Audard V, Georges B, Vanhille P, Toly C, Deroure B, Fakhouri F, Cuvelier R, Belenfant X, Surin B, Aucouturier P, Mougenot B, Ronco P. Renal lesions associated with IgM-secreting monoclonal proliferations: revisiting the disease spectrum. Clin J Am Soc Nephrol. 2008;3:1339–49.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Sethi S, Zand L, Leung N, Smith RJ, Jevremonic D, Herrmann SS, Fervenza FC. Membranoproliferative glomerulonephritis secondary to monoclonal gammopathy. Clin J Am Soc Nephrol. 2010;5:770–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Tsuji M, Ochiai S, Taka T, Hishitani Y, Nagareda T, Mori H. Nonamyloidotic nephrotic syndrome in Waldenström’s macroglobulinemia. Nephron. 1990;54:176–8.

    Article  CAS  PubMed  Google Scholar 

  8. Lima J, Monteagudo M, Valles M, Garcia-Bragado F, Carrera M, Vilardell M. Proliferative endo- and extracapillary glomerulonephritis and benign monoclonal IGM gammopathy. Nephron. 1990;56:457–8.

    Article  CAS  PubMed  Google Scholar 

  9. Veltman GA, van Veen S, Kluin-Nelemans JC, Bruijn JA, van Es LA. Renal disease in Waldenström’s macroglobulinaemia. Nephrol Dial Transplant. 1997;12:1256–9.

    Article  CAS  PubMed  Google Scholar 

  10. Yahata M, Nakaya I, Takahashi S, Sakuma T, Sato H, Soma J. Proliferative glomerulonephritis with monoclonal IgM deposits without Waldenström’s macroglobulinemia: case report and review of the literature. Clin Nephrol. 2012;77:254–60.

    Article  PubMed  Google Scholar 

  11. Miura N, Uemura Y, Suzuki N, Suga N, Maeda K, Yamaguchi S, Kitagawa W, Yamada H, Nishikawa K, Imai H. An IgA1-lambda-type monoclonal immunoglobulin deposition disease associated with membranous features in a patient with chronic hepatitis C viral infection and rectal cancer. Clin Exp Nephrol. 2010;14:90–3.

    Article  PubMed  Google Scholar 

  12. Nasr SH, Sethi S, Cornell LD, Fidler ME, Boelkins M, Fervenza FC, Cosio FG, D’Agati VD. Proliferative glomerulonephritis with monoclonal IgG deposits recurs in the allograft. Clin J Am Soc Nephrol. 2011;6:122–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Ranghino A, Tamagnone M, Messina M, Barreca A, Biancone L, Basolo B, Segoloni GP, Mazzucco G. A case of recurrent proliferative glomerulonephritis with monoclonal IgG deposits after kidney transplant treated with plasmapheresis. Case Rep Nephrol Urol. 2012;2:46–52.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Sumida K, Ubara Y, Marui Y, Nakamura M, Takaichi K, Tomikawa S, Fujii T, Ohashi K. Recurrent proliferative glomerulonephritis with monoclonal IgG deposits of IgG2λ subtype in a transplanted kidney: a case report. Am J Kidney Dis. 2013;62:587–90.

    Article  PubMed  Google Scholar 

  15. Tewari R, Joshi K, Kumar A, Rayat CS, Iyer R, Sakhuja V, Minz M. Early recurrence of proliferative glomerulonephritis with monoclonal immunoglobulin deposits in a renal allograft. Saudi J Kidney Dis Transpl. 2016;27:381–5.

    Article  PubMed  Google Scholar 

  16. Herrmann SM, Govani MV, Fidler ME, Nasr SH, Klink D, Amin C, Leung N, Fervenza FC. Recurrence of monoclonal IgA lambda glomerulonephritis in kidney allograft associated with multiple myeloma. Clin Nephrol. 2015;84:241–6.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Otemae Hospital, 5-34 Otemae 1-chome, Chuo-ku, Osaka, 540-0008, Japan

    Yoshito Yamaguchi

  2. Yamagata Prefectural University of Health Sciences, Yamagata, Japan

    Kunihiko Maeda

  3. Department of Nephrology, Osaka Rosai Hospital, Osaka, Japan

    Yoshito Yamaguchi, Katsuyuki Nagatoya & Atsushi Yamauchi

Authors
  1. Yoshito Yamaguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kunihiko Maeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Katsuyuki Nagatoya
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Atsushi Yamauchi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yoshito Yamaguchi.

Ethics declarations

Conflict of interest

The authors have declared that no conflict of interest exists.

Human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

Informed consent was obtained from the patient included in this article.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yamaguchi, Y., Maeda, K., Nagatoya, K. et al. A case report of proliferative glomerulonephritis with monoclonal immunoglobulin M-kappa deposits without associated lymphoproliferative disorder or detectable paraproteinemia. CEN Case Rep 7, 55–61 (2018). https://doi.org/10.1007/s13730-017-0291-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13730-017-0291-0

Keywords

Search

Navigation