Chronological change of renal pathological findings in the proliferative glomerulonephritis with monoclonal IgG deposits considered to have recurred early after kidney transplantation
Chronological change of renal pathological findings in the proliferative glomerulonephritis with monoclonal IgG deposits considered to have recurred early after kidney transplantation
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肾移植后早期复发伴单克隆 IgG 沉积的增殖性肾小球肾炎肾脏病理结果的时间变化
DOI：
10.1007/s13730-019-00384-6
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发表时间：
2019
期刊：
影响因子：
1
通讯作者：
S. Maruyama
中科院分区：
文献类型：
--
作者：
Takayuki Katsuno;Masashi Kato;T. Fujita;N. Tsuboi;R. Hattori;Yasuhiko Ito;S. Maruyama
单克隆免疫球蛋白G （IgG）沉积（PGNMID）的增生性肾小球肾炎是一种罕见的疾病，最近才被认识到。其病理表现为单个重链亚类和单个轻链同型的沉积。PGNMID已被证实在同种异体肾移植中复发。在这里，作者描述了一个46岁的男子谁提出肾病综合征和肾移植后进行性肾损伤的情况。移植后1个月临床情况稳定；然而，方案活检显示免疫荧光染色在肾小球上沉积IgG和补体。电镜显示系膜中有粒状的电子致密沉积物。此后，由于蛋白尿水平升高，再次行肾活检。增生性肾小球肾炎以系膜为主，伴IgG和补体沉积，系膜及内皮下EDD；但病理诊断困难。肾移植术后4年零10个月再次行肾活检。观察到肾小球沉积在单一IgG亚类和单一轻链同型（IgG3 kappa）上，具有膜增生性特征。电镜下可见大量内皮下EDD，最终诊断为PGNMID。由于移植后1个月PGNMID似乎已经发展，我们考虑同种异体移植中复发的PGNMID病例。PGNMID的治疗方法尚未确定，即使在这种情况下，移植物功能最终也会丧失。为了改善肾脏预后，早期诊断和进一步研究治疗是必要的。
Proliferative glomerulonephritis with monoclonal immunoglobulin G (IgG) deposits (PGNMID) is a rare disease that recently became recognized. Its pathological findings are characterized by the deposition of a single heavy chain subclass and a single light chain isotype. PGNMID has been proven to recur in renal allografts. Herein, the authors describe the case of a 46-year-old man who presented with nephrotic syndrome and progressive kidney injury following kidney transplantation. One month after transplantation, his clinical condition stabilized; however, the protocol biopsy showed depositions of IgG and complement on the glomeruli by immunofluorescence staining. Electron microscopy (EM) revealed granular electron-dense deposits (EDD) in the mesangium. Thereafter, renal biopsy was repeated because his proteinuria level increased. Proliferative glomerulonephritis, mainly in the mesangium, with IgG and complement deposits and mesangial and subendothelial EDD were observed; however, the pathological diagnosis was difficult. Renal dysfunction then became apparent, and renal biopsy was performed again 4 years and 10 months after kidney transplantation. Glomerular deposits on a single IgG subclass and a single light chain isotype (IgG3 kappa) with membranoproliferative features were observed. Abundant subendothelial EDD were detected on EM. Finally, the patient was diagnosed with PGNMID. Since it seemed that PGNMID had already developed at 1 month after transplantation, we considered recurrent PGNMID case in the allograft. The treatment for PGNMID has not been established yet, and even in this case, the graft function was eventually lost. For improving renal prognosis, early diagnosis and further investigation on the treatment are necessary.
影响因子：
13.2
作者：
Albawardi, Alia;Satoskar, Anjali;Nadasdy, Tibor
通讯作者：
Nadasdy, Tibor
影响因子：
13.6
作者：
O'Shaughnessy, Michelle M.;Liu, Sai;Winkelmayer, Wolfgang C.
通讯作者：
Winkelmayer, Wolfgang C.