IgM Variant of Proliferative Glomerulonephritis With Monoclonal Immunoglobulin Deposits: A Case Series
Abstract
RATIONALE & OBJECTIVE
Most deposits in proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID) are of the IgG class. The IgM variant (PGNMID-IgM) is very rare, and data are mostly derived from single case reports or cases associated with B-cell lymphoproliferative disorders. We describe the clinicopathologic characteristics and outcomes among cases of PGNMID-IgM.
STUDY DESIGN
Case series.
SETTING & PARTICIPANTS
23 PGNMID-IgM cases were identified from kidney pathology archives. PGNMID-IgM was defined by glomerulonephritis with glomerular granular monotypic IgM deposits after excluding cryoglobulinemic glomerulonephritis and intracapillary monoclonal deposits disease.
FINDINGS
Seventy-eight percent of the cases were male, they had a median age of 72 years, and presented with proteinuria (median 3.1 g/day), hematuria (91%), and reduced eGFR (median serum creatinine 1.9 mg/dL). Hypocomplementemia was present in 31% of cases. The underlying hematologic condition for all cases was monoclonal gammopathy of renal significance (MGRS). Serum protein electrophoresis/serum immunofixation (SPEP/SIF) detected the nephropathic MIg in 27%, whereas matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF) detected the nephropathic IgM in 4 of 7 tested patients. Kidney biopsy revealed MPGN (83%) with non-organized glomerular monotypic IgM (100%) and C3 deposition (96%), while C1q deposition was rare. Seventeen percent received…
How strong is the evidence?
Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health. Reported size: 7 participants or records.
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