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Abstract: PO1918

A Rare Case of Monoclonal Gammopathy of Renal Significance

Session Information

Category: Onco-Nephrology

  • 1500 Onco-Nephrology

Authors

  • Malik, Jawad I., University of Maryland Medical Center, Baltimore, Maryland, United States
  • Bolanos, Jonathan Alexis, University of Maryland Medical Center, Baltimore, Maryland, United States
Introduction

Monoclonal gammapathy of renal significance represents a group of disorders in which monoclonal immunoglobulin secreted by a non malignant or premalignant B cell or plasma cell clone causes renal damage. These disorders do not meet diagnostic criteria for multiple myleoma or lymphoproliferative disorder.

Case Description

64 year old female with hx of hypertension, presented to ED for worsening lower extremity edema, dyspnea.She was admitted for CHF exaceration. Admission creatnine was 2.0( prior baseline 1.0). She developed resistence to diuretics with worsening renal failure requriing dialysis. She had 6.0 grams of proteinuria. Kidney biopsy showed ATN, and findings consistent with PGNMIG with IG3k. She had spep/upep/free light chains ratio which were all normal. Bone marrow biopsy was normal. Since no clone had been identified to guide treatment, plan made to treat her with bortexumib, cytoxan and dexamethasone.

Discussion

-PGNMIG is a monclonal gamopathy which resembles immune complex GN
- Most comman pattern seen in PGNMIG is IG3k( this is more nephritogenic and has ability to activate compliment cascade causing inflammatory damage. Majority of the patient with PGNMID do not have clone identified. In such patients treatment is empiric with bortexumib/cytoxan/dexamethasone or rituximab.