Successful treatment with bortezomib and dexamethasone for proliferative glomerulonephritis with monoclonal IgG deposits in multiple myeloma: a case report

Abstract Background Proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) is a form of renal involvement by monoclonal IgG deposits that was found in mesangial, subendothelial or subepithelial regions. The distribution of glomerular deposits was completely different from that in mon...

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Main Authors: Rio Noto, Nozomu Kamiura, Yuichiro Ono, Sumie Tabata, Shigeo Hara, Hideki Yokoi, Akihiro Yoshimoto, Motoko Yanagita
Format: Article
Language:English
Published: BMC 2017-04-01
Series:BMC Nephrology
Subjects:
Online Access:http://link.springer.com/article/10.1186/s12882-017-0524-7
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spelling doaj-0c655d01c54d497686c3ff3a12f0e3ed2020-11-24T23:29:57ZengBMCBMC Nephrology1471-23692017-04-011811610.1186/s12882-017-0524-7Successful treatment with bortezomib and dexamethasone for proliferative glomerulonephritis with monoclonal IgG deposits in multiple myeloma: a case reportRio Noto0Nozomu Kamiura1Yuichiro Ono2Sumie Tabata3Shigeo Hara4Hideki Yokoi5Akihiro Yoshimoto6Motoko Yanagita7Department of Clinical Nephrology, Kobe City Medical Center General HospitalDepartment of Clinical Nephrology, Kobe City Medical Center General HospitalDepartment of Clinical Hematology, Kobe City Medical Center General HospitalDepartment of Clinical Hematology, Kobe City Medical Center General HospitalDepartment of Diagnostic Pathology, Kobe University HospitalDepartment of Nephrology, Kyoto University Graduate School of MedicineDepartment of Clinical Nephrology, Kobe City Medical Center General HospitalDepartment of Nephrology, Kyoto University Graduate School of MedicineAbstract Background Proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) is a form of renal involvement by monoclonal IgG deposits that was found in mesangial, subendothelial or subepithelial regions. The distribution of glomerular deposits was completely different from that in monoclonal immunoglobulin deposition disease. PGNMID is reported to be rarely associated with a hematological malignancy. Previously, only five cases of PGNMID with multiple myeloma have been reported. However, the pathogenic relationship between PGNMID and multiple myeloma was unclear because a detailed description was not provided. We report that a patient with PGNMID associated with multiple myeloma was treated with bortezomib and dexamethasone and underwent the second renal biopsy after treatment, showing that chemotherapy was effective for PGNMID clinically and pathologically. Case presentation A 75-year-old man presented with progressive leg edema, had nephrotic range proteinuria, hypoalbuminemia, moderate renal failure, and occult blood in his urine. Electrophoresis results showed serum and urinary monoclonal spikes of IgGκ type immunoglobulin. A renal biopsy specimen showed lobular mesangial proliferation with mesangiolysis, glomerular micro-aneurysm, and endocapillary hypercellularity. Immunofluorescence results revealed strong granular capillary and mesangial staining for IgG1, C3 and κ light chain in glomeruli without tubular deposits of any immunoglobulin. Electron microscopy also showed dense granular deposits in subendothelial and mesangial areas. PGNMID associated with multiple myeloma (IgGκ type) was diagnosed on the basis of a subsequent bone marrow examination. Bortezomib and dexamethasone therapy significantly reduced proteinuria and elevated serum albumin level. Eight months later, the second renal biopsy showed no active lesions and that the IgG1 and κ light chain deposits had drastically disappeared. Conclusions This is the first case of PGNMID with multiple myeloma successfully treated with bortezomib and dexamethasone in which comparative renal biopsies were performed before and after treatment. Our findings suggest the pathogenesis of PGNMID and therapeutic options for PGNMID.http://link.springer.com/article/10.1186/s12882-017-0524-7Proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID)Multiple myelomaMonoclonal gammopathy
collection DOAJ
language English
format Article
sources DOAJ
author Rio Noto
Nozomu Kamiura
Yuichiro Ono
Sumie Tabata
Shigeo Hara
Hideki Yokoi
Akihiro Yoshimoto
Motoko Yanagita
spellingShingle Rio Noto
Nozomu Kamiura
Yuichiro Ono
Sumie Tabata
Shigeo Hara
Hideki Yokoi
Akihiro Yoshimoto
Motoko Yanagita
Successful treatment with bortezomib and dexamethasone for proliferative glomerulonephritis with monoclonal IgG deposits in multiple myeloma: a case report
BMC Nephrology
Proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID)
Multiple myeloma
Monoclonal gammopathy
author_facet Rio Noto
Nozomu Kamiura
Yuichiro Ono
Sumie Tabata
Shigeo Hara
Hideki Yokoi
Akihiro Yoshimoto
Motoko Yanagita
author_sort Rio Noto
title Successful treatment with bortezomib and dexamethasone for proliferative glomerulonephritis with monoclonal IgG deposits in multiple myeloma: a case report
title_short Successful treatment with bortezomib and dexamethasone for proliferative glomerulonephritis with monoclonal IgG deposits in multiple myeloma: a case report
title_full Successful treatment with bortezomib and dexamethasone for proliferative glomerulonephritis with monoclonal IgG deposits in multiple myeloma: a case report
title_fullStr Successful treatment with bortezomib and dexamethasone for proliferative glomerulonephritis with monoclonal IgG deposits in multiple myeloma: a case report
title_full_unstemmed Successful treatment with bortezomib and dexamethasone for proliferative glomerulonephritis with monoclonal IgG deposits in multiple myeloma: a case report
title_sort successful treatment with bortezomib and dexamethasone for proliferative glomerulonephritis with monoclonal igg deposits in multiple myeloma: a case report
publisher BMC
series BMC Nephrology
issn 1471-2369
publishDate 2017-04-01
description Abstract Background Proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) is a form of renal involvement by monoclonal IgG deposits that was found in mesangial, subendothelial or subepithelial regions. The distribution of glomerular deposits was completely different from that in monoclonal immunoglobulin deposition disease. PGNMID is reported to be rarely associated with a hematological malignancy. Previously, only five cases of PGNMID with multiple myeloma have been reported. However, the pathogenic relationship between PGNMID and multiple myeloma was unclear because a detailed description was not provided. We report that a patient with PGNMID associated with multiple myeloma was treated with bortezomib and dexamethasone and underwent the second renal biopsy after treatment, showing that chemotherapy was effective for PGNMID clinically and pathologically. Case presentation A 75-year-old man presented with progressive leg edema, had nephrotic range proteinuria, hypoalbuminemia, moderate renal failure, and occult blood in his urine. Electrophoresis results showed serum and urinary monoclonal spikes of IgGκ type immunoglobulin. A renal biopsy specimen showed lobular mesangial proliferation with mesangiolysis, glomerular micro-aneurysm, and endocapillary hypercellularity. Immunofluorescence results revealed strong granular capillary and mesangial staining for IgG1, C3 and κ light chain in glomeruli without tubular deposits of any immunoglobulin. Electron microscopy also showed dense granular deposits in subendothelial and mesangial areas. PGNMID associated with multiple myeloma (IgGκ type) was diagnosed on the basis of a subsequent bone marrow examination. Bortezomib and dexamethasone therapy significantly reduced proteinuria and elevated serum albumin level. Eight months later, the second renal biopsy showed no active lesions and that the IgG1 and κ light chain deposits had drastically disappeared. Conclusions This is the first case of PGNMID with multiple myeloma successfully treated with bortezomib and dexamethasone in which comparative renal biopsies were performed before and after treatment. Our findings suggest the pathogenesis of PGNMID and therapeutic options for PGNMID.
topic Proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID)
Multiple myeloma
Monoclonal gammopathy
url http://link.springer.com/article/10.1186/s12882-017-0524-7
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