Abstract: SA-PO168
De Novo Proliferative Glomerulonephritis with Monoclonal Immunoglobulin Deposits After Allogeneic Stem Cell Transplant
Session Information
- Onco-Nephrology: Clinical
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onco-Nephrology
- 1500 Onco-Nephrology
Authors
- St.pierre, Lynn M., Mayo Clinic, Scottsdale, Arizona, United States
- Seipp, Regan M., Mayo Clinic, Scottsdale, Arizona, United States
- Smith, Maxwell L., Mayo Clinic, Scottsdale, Arizona, United States
- Thomas, Leslie F., Mayo Clinic, Scottsdale, Arizona, United States
- Hommos, Musab S., Mayo Clinic, Scottsdale, Arizona, United States
Introduction
Proliferative Glomerulonephritis with Monoclonal Immunoglobulin Deposits (PGNMID) is a rare form of monoclonal gammopathy of renal significance (MGRS). Here we describe an unusual presentation of de novo PGNMID occurring in patient who underwent allogeneic stem cell transplant two years prior to the diagnosis.
Case Description
A 71-year-old male underwent matched related allogeneic stem cell transplant (SCT) for acute myelogenous leukemia (AML). The donor was the patient's brother. The patient's relevant medical problems at the time of transplant included enlarged prostate, status post prostatectomy, and previous acute kidney injury events attributed to sepsis and hypotension in the setting of chemotherapy administered for AML. At the time of transplant, serum creatinine was 1.5 mg/dL (eGFR 47 ml/min). Urinalysis was devoid of hematuria and proteinuria. Post SCT, he developed graft vs host disease involving the gastrointestinal tract which was treated with steroids. Subsequent restaging bone marrow biopsies showed no residual AML. Two years post SCT, he developed nephrotic syndrome associated with a rapid rise in serum creatinine to 4.5 mg/dL (eGFR 12 ml/min), and hematuria. Serum testing showed a new monoclonal IgG kappa, and kappa free light chain of 4.8 mg/dL (kappa/lambda ratio of 2). Kidney biopsy revealed a diffuse mesangial and endocapillary proliferative glomerulonephritis with immunofluorescence microscopy revealing capillary loop pseudolinear reactivity for IgG (2+), kappa (2+), and C3 (3+), with no reactivity for lambda. A subsequent bone marrow biopsy was negative for plasma cell neoplasm or lymphoma as was the flow cytometric analysis.
Discussion
To our knowledge, this is the first reported case of PGNMID following allogenic SCT. Similar to many other reported cases, a plasma cell clone was not identified via histologic examination of the bone marrow. Given the time of PGNMID diagnosis post SCT, transfer of plasma cell disorder from the donor is one consideration to explore by testing the donor for monoclonal dysproteinemia. This case illustrates the importance of considering MGRS in the differential diagnosis of kidney disease and proteinuria in patients with history of stem cell transplant.