Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 6, 2021; 9(10): 2357-2366
Published online Apr 6, 2021. doi: 10.12998/wjcc.v9.i10.2357
Proliferative glomerulonephritis with monoclonal immunoglobulin G deposits in a young woman: A case report
Zi-Gan Xu, Wei-Long Li, Xi Wang, Shu-Yuan Zhang, Ying-Wei Zhang, Xing Wei, Chun-Di Li, Ping Zeng, Shao-Dong Luan
Zi-Gan Xu, Wei-Long Li, Xi Wang, Shu-Yuan Zhang, Ying-Wei Zhang, Xing Wei, Chun-Di Li, Ping Zeng, Shao-Dong Luan, Department of Nephrology, Shenzhen Longhua District Central Hospital, Shenzhen 518110, Guangdong Province, China
Author contributions: Xu ZG reviewed the literature and contributed to manuscript drafting; Li WL, Wang X, Zhang SY, Zhang YW, Li CD, and Zeng P collected the information from the patient; Wei X and Luan SD were surgeons for biopsy and revised the manuscript; Luan SD supervised the study; all authors read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shao-Dong Luan, PhD, Chief Doctor, Department of Nephrology, Shenzhen Longhua District Central Hospital, No. 187 Guanlan Road, Shenzhen 518110, Guangdong Province, China. szkidney3@163.com
Received: November 11, 2020
Peer-review started: November 11, 2020
First decision: December 21, 2020
Revised: January 2, 2021
Accepted: January 27, 2021
Article in press: January 27, 2021
Published online: April 6, 2021
Abstract
BACKGROUND

Proliferative glomerulonephritis with monoclonal immunoglobulin G (IgG) deposits (PGNMID) is a newly recognized rare disease. The renal pathology is characterized by prominent manifestations of membranous hyperplasia, which are easy to misdiagnose. The clinical symptoms are severe. Massive proteinuria and hypoproteinemia are conspicuous, and most patients are accompanied by renal insufficiency and microscopic hematuria.

CASE SUMMARY

A 27-year-old woman was admitted to a hospital for macroscopic hematuria and proteinuria 4 years prior, and renal biopsy in the hospital suggested moderate-to-severe mesangial proliferating glomerulonephritis (MsPGN). She had taken a glucocorticoid, cyclophosphamide, mycophenolate mofetil, and other treatments and achieved brief partial remission. Recently, the patient visited our hospital due to massive proteinuria. Repeated renal biopsy and re-evaluation of the first biopsy obtained 4 years previously revealed monoclonal immunoglobulin deposition in the glomeruli. A bone marrow examination was performed to exclude hematologic malignancy, and a diagnosis of PGNMID was established. The patient showed remission after four cycles of a bortezomib + cyclophosphamide + dexamethasone scheme.

CONCLUSION

PGNMID is usually misdiagnosed as MsPGN or membranoproliferative glomerulonephritis. Although it often occurs in middle-aged and elderly individuals, it cannot be readily excluded in young people, even when serum immunofixation electrophoresis is negative. IgG subtype and light chain staining are necessary when this disease is highly suspected. An accurate diagnosis at the earliest stage may avoid the overuse of glucocorticoids and immunosuppressants.

Keywords: Proliferative glomerulonephritis with monoclonal immunoglobulin G deposits, Renal insufficiency, Second renal biopsy, Young female, Bortezomib, Case report

Core Tip: Proliferative glomerulonephritis with monoclonal immunoglobulin G deposits (PGNMID) is a rare renal disease whose pathogenesis is not fully understood. Due to its complexity, this disease is easy to misdiagnose. We report the case of a young female patient with gross hematuria and foamy urine. Renal biopsy in another hospital suggested mesangial proliferating glomerulonephritis (MsPGN). Her condition did not improve significantly after treatment with glucocorticoids and immuno-suppressants. Recently, repeated renal biopsy at our hospital suggested PGNMID. This case suggests that although PGNMID often occurs in middle-aged and elderly individuals, it cannot be readily excluded in young people with the pathological type of membranoproliferative glomerulonephritis or MsPGN, even when immunofixation electrophoresis is negative. An accurate diagnosis at the earliest stage may minimize the use of glucocorticoids and immunosuppressants.