Advertisment
Indian Journal of Nephrology About us |  Subscription |  e-Alerts  | Feedback | Login   
  Print this page Email this page   Small font sizeDefault font sizeIncrease font size
 Home | Current Issue | Archives| Ahead of print | Search |Instructions |  Editorial Board  

Users Online:165

Official publication of the Indian Society of Nephrology
  Search
 
  
 ~  Similar in PUBMED
 ~  Search Pubmed for
 ~  Search in Google Scholar for
 ~  Article in PDF (490 KB)
 ~  Citation Manager
 ~  Access Statistics
 ~  Reader Comments
 ~  Email Alert *
 ~  Add to My List *
* Registration required (free)  

 
   References
   Article Figures

 Article Access Statistics
    Viewed1181    
    Printed15    
    Emailed0    
    PDF Downloaded78    
    Comments [Add]    

Recommend this journal

 


 
  Table of Contents  
LETTER TO EDITOR
Year : 2015  |  Volume : 25  |  Issue : 3  |  Page : 187-188
 

Glomerulonephritis with monoclonal IgG deposits


Department of Nephrology, Sawai Man Singh Hospital, Jaipur, Rajasthan, India

Date of Web Publication13-May-2015

Correspondence Address:
K Gandhi
Department of Nephrology, Sawai Man Singh Hospital, Jaipur, Rajasthan
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-4065.153327

Rights and Permissions



How to cite this article:
Gandhi K, Prasad D, Malhotra V, Beniwal P. Glomerulonephritis with monoclonal IgG deposits. Indian J Nephrol 2015;25:187-8

How to cite this URL:
Gandhi K, Prasad D, Malhotra V, Beniwal P. Glomerulonephritis with monoclonal IgG deposits. Indian J Nephrol [serial online] 2015 [cited 2020 Mar 30];25:187-8. Available from: http://www.indianjnephrol.org/text.asp?2015/25/3/187/153327


Sir,

We identified six cases with a pathological diagnosis of glomerulonephritis with monoclonal IgG deposits from over 200 renal biopsy samples performed at Sawai Man Singh Hospital, Jaipur, from June 2012 to January 2014. Of the six, five were males and one female. The mean age was 43 years. All of them presented with proteinuria, and two had nephrotic syndrome. Four patients each had renal insufficiency and microhematuria, while 3 had hypertension. Histological patterns were predominantly membranoproliferative (four) or diffuse proliferative (two), glomerulonephritis. Crescents were seen in two, which were predominantly fibrocellular with few scattered cellular crescents. Immunofluorescence demonstrated glomerular deposits staining for a single light chain isotype (kappa or lambda) and a single heavy chain (IgG) [Figure 1]. None of the biopsy stained for IgA, M or G in tubular basement membrane or interstitium. Due to lack of facilities, we were unable to perform electron microscopy. None of them had paraproteinemia. Serum cryoglobulin titers and complement levels were normal in all. Antinuclear antibody, hepatitis B surface antigen, anti-hepatitis B virus antibody and rheumatoid factor were negative. All of them were treated with immunosuppressants based on the renal functions and followed-up for six months. Two patients had complete remission, one maintained stable renal function and two progressed to end stage renal disease. None of the patients developed signs and symptoms of multiple myeloma during follow-up.
Figure 1: (a) Light microscopy suggestive of proliferative glomerulonephritis (b-d) immunofluorescence showing a predominant IgG and kappa deposition

Click here to view


Glomerulonephritis with monoclonal IgG deposits is characterized by monoclonal deposits, which stain for single light chain isotype and single gamma subclass. [1] The differential diagnosis includes type 1 cryoglobulinemic glomerulonephritis, light- and heavy-chain amyloidosis, immunotactoid glomerulonephritis, fibrillary glomerulonephritis and proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID). Electron microscopy and pathological review are mandatory to differentiate between these pathologies. [1],[2]

While light microscopy and monoclonality on immunofluorescence are highly suggestive, electron microscopy is required to confirm the diagnosis [3] and differentiate it from immunotactoid or fibrillary glomerulonephritis.

 
  References Top

1.
Nasr SH, Markowitz GS, Reddy BS, Maesaka J, Swidler MA, D′Agati VD. Dysproteinemia, proteinuria, and glomerulonephritis. Kidney Int 2006;69:772-5.  Back to cited text no. 1
    
2.
Rosenstock JL, Markowitz GS, Valeri AM, Sacchi G, Appel GB, D′Agati VD. Fibrillary and immunotactoid glomerulonephritis: Distinct entities with different clinical and pathologic features. Kidney Int 2003;63:1450-61.  Back to cited text no. 2
    
3.
Nasr SH, Markowitz GS, Stokes MB, Seshan SV, Valderrama E, Appel GB, et al. Proliferative glomerulonephritis with monoclonal IgG deposits: A distinct entity mimicking immune-complex glomerulonephritis. Kidney Int 2004;65:85-96.  Back to cited text no. 3
    


    Figures

  [Figure 1]



 

Top
Print this article  Email this article
 

    

Indian Journal of Nephrology
Published by Wolters Kluwer - Medknow
Online since 20th Sept '07