Membranoproliferative glomerulonephritis secondary to monoclonal gammopathy

Sanjeev Sethi; Ladan Zand; Nelson Leung; Richard J H Smith; Dragan Jevremonic; Sandra S Herrmann; Fernando C Fervenza

doi:10.2215/cjn.06760909

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Membranoproliferative glomerulonephritis secondary to monoclonal gammopathy

Journal article

Open access

Membranoproliferative glomerulonephritis secondary to monoclonal gammopathy

Sanjeev Sethi, Ladan Zand, Nelson Leung, Richard J H Smith, Dragan Jevremonic, Sandra S Herrmann and Fernando C Fervenza

Clinical journal of the American Society of Nephrology, Vol.5(5), pp.770-782

05/2010

DOI: 10.2215/cjn.06760909

PMCID: PMC2863981

PMID: 20185597

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Abstract

Membranoproliferative glomerulonephritis (MPGN) is an immune complex-mediated glomerulonephritis characterized by subendothelial and mesangial deposition of immune complexes. Autoimmune diseases and chronic infections, such as hepatitis C, are commonly recognized causes of MPGN; however, monoclonal gammopathy is a less widely recognized cause of MPGN. We reviewed all renal biopsies of MPGN in Mayo Clinic patients during a 6-year period to determine the association of monoclonal gammopathy with MPGN. Results were correlated with electrophoresis studies and bone marrow biopsies to clarify the relationship between MPGN and gammopathies. Of 126 patients with MPGN, 20 did not have workup for hepatitis B or C. Of the remaining 106 patients, 25 (23.5%) were positive for hepatitis B or C. Of the 81 hepatitis-negative patients, 13 were not evaluated for gammopathies. Of the remaining 68 patients, 28 (41.1%) had serum and/or urine electrophoresis studies positive for monoclonal gammopathy. Serum immunofixation electrophoresis was the most sensitive method for diagnosing monoclonal gammopathy. Renal biopsy showed a membranoproliferative pattern of injury; immunofluorescence microscopy was often instrumental in diagnosing the underlying gammopathy. On the basis of the bone marrow biopsy, monoclonal gammopathy of undetermined significance was the most common entity associated with MPGN. Other, less common causes included multiple myeloma, low-grade B cell lymphoma, and chronic lymphocytic leukemia. Monoclonal gammopathy is an important and common cause of MPGN; therefore, all patients with a diagnosis of MPGN should be evaluated for an underlying monoclonal gammopathy.

Bone Marrow - immunology

Kidney - pathology

Humans

Middle Aged

Kidney - immunology

Male

Antibodies, Monoclonal - blood

Paraproteinemias - pathology

Time Factors

Aged, 80 and over

Adult

Female

Paraproteinemias - immunology

Glomerulonephritis, Membranoproliferative - pathology

Blood Protein Electrophoresis

Paraproteinemias - therapy

Treatment Outcome

Paraproteinemias - complications

Antibodies, Monoclonal - urine

Bone Marrow Examination

Glomerulonephritis, Membranoproliferative - therapy

Glomerulonephritis, Membranoproliferative - immunology

Biopsy

Bone Marrow - pathology

Fluorescent Antibody Technique

Aged

Details

Title: Subtitle: Membranoproliferative glomerulonephritis secondary to monoclonal gammopathy
Creators: Sanjeev Sethi - Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA. sethi.sanjeev@mayo.edu
Ladan Zand
Nelson Leung
Richard J H Smith
Dragan Jevremonic
Sandra S Herrmann
Fernando C Fervenza
Resource Type: Journal article
Publication Details: Clinical journal of the American Society of Nephrology, Vol.5(5), pp.770-782
DOI: 10.2215/cjn.06760909
PMID: 20185597
PMCID: PMC2863981
NLM abbreviation: Clin J Am Soc Nephrol
ISSN: 1555-905X
eISSN: 1555-905X
Publisher: United States
Grant note: R01 DK074409 / NIDDK NIH HHS DK074409 / NIDDK NIH HHS
Language: English
Date published: 05/2010
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Molecular Physiology and Biophysics; Anatomy and Cell Biology; Stead Family Department of Pediatrics; Iowa Neuroscience Institute; Otolaryngology; Internal Medicine
Record Identifier: 9984006402602771

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