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Diagnosis: Membranous Glomerulonephritis with Monoclonal IgG/kappa Deposits
Membranous glomerulopathy is a common cause of nephrotic syndrome that results from the formation of immune complexes along the subepithelial aspect of the glomerular basement membranes. Although it is most frequently caused by polytypic deposits, cases with light chain isotype-restricted deposits are rarely seen. Numerous case reports and case series detailing glomerular diseases caused by nonorganized monotypic Ig deposits showing a mesangial proliferative, endocapillary proliferative, or membranoproliferative pattern of glomerular injury have been published, and, depending on the clinical scenario, have been found to be both associated with and independent of underlying lymphoproliferative disorders. However, relatively few case reports and small case series have described a membranous pattern of immune complex deposition with monotypic deposits (Best Rocha A, Larsen CP. Kidney Int Rep. 2017;2(6):1141-1148. [PubMed link]).
In our case, a B cell small lymphocytic lymphoma was found in the patient.
See the chapter: Membranous Glomerulonephritis of our Tutorial.
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References
- Best Rocha A, Larsen CP. Membranous Glomerulopathy With Light Chain-Restricted Deposits: A Clinicopathological Analysis of 28 Cases. Kidney Int Rep. 2017;2(6):1141-1148. [PubMed link]
- Larsen CP, Boils CL, Cossey LN. Clinicopathologic features of membranous-like glomerulopathy with masked IgG kappa deposits. Kidney Int Rep. 2016;1(4):299-305. [PubMed link]
- Yamada T1, Arakawa Y, Mii A, Kashiwagi T, Kaneko T, Utsumi K, Masuda Y, Shimizu A, Iino Y, Katayama Y. A case of monoclonal immunoglobulin G1-lambda deposition associated with membranous feature in a patient with hepatitis C viral infection. Clin Exp Nephrol. 2012;16(3):468-72. [PubMed link]
- Omokawa A, Komatsuda A, Hirokawa M. Membranous nephropathy with monoclonal IgG4 deposits and associated IgG4-related lung disease. Clin Kidney J. 2014;7:475–478. [PubMed link]
- Strati P, Nasr S.H, Leung N. Renal complications in chronic lymphocytic leukemia and monoclonal B-cell lymphocytosis: the Mayo Clinic experience. Haematologica. 2015;100(9):1180-8. [PubMed link].