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Abstract: FR-PO176

Use of Daratumumab in a Patient With Proliferative Glomerulonephritis With Monoclonal Immunoglobulin Deposition

Session Information

Category: Onconephrology

  • 1600 Onconephrology


  • Doddi, Akshith, West Virginia University, Morgantown, West Virginia, United States
  • Ibrahim, Dalia Y., The Ohio State University, Columbus, Ohio, United States
  • Shawwa, Khaled, West Virginia University, Morgantown, West Virginia, United States

Monoclonal gammopathy of renal significance is a pathogenic entity associated with end stage kidney disease. Proliferative glomerulonephritis with monoclonal immunoglobulin deposition (PGNMID) results from deposition of a monoclonal immunoglobulin leading to kidney damage. Until recently there was no evidence to guide treatment. We report a case of a patient with PGNMID who responded well to daratumumab.

Case Description

This is a 57-year-old female with diabetes of 3 years duration and hypertension. She presented with worsening swelling of a couple weeks duration and was found to have anasarca. Her serum albumin was 1.4 mg/dL, serum creatinine 1.8 mg/dL and had 3-5 red blood cells per high power field in her urine. She was started on intravenous diuretics. Her 24-hour urine protein was 7.3 grams. Her complement levels C3 and C4, ANA, ANCA, hepatitis B and C were negative or normal. The patient’s kappa (5.2 mg/dL) and lambda (2.7 mg/dL) free light chains were slightly elevated. Her urine and serum protein electrophoresis did not show a monoclonal protein. A kidney biopsy was done. There was moderate focal segmental mesangial expansion with hypercellularity with no endocapillary hypercellularity. Immunofluorescence (IF) showed moderate diffuse mesangial staining for IgG and C3 with kappa light chain restriction. IF with antibodies for IgG subclasses showed a predominantly IgG1 subclass staining. Electron microscopy revealed electron dense immune-type deposits in the mesangium and a few subepithelial and intramembranous deposits. The patient was diagnosed with PGNMID. A bone marrow biopsy and skeletal survey were negative. She was given rituximab. She was then referred 3 months later for a second opinion due to a continued nephrotic syndrome and decreased kidney function. She proceeded with daratumumab based on Zand et al protocol. After completing the first 8 doses, her creatinine improved to 1.5 mg/dL from 4 mg/dL at time of initial infusion. She continued to have proteinuria until after her 10th infusion, where it improved down to 0.6 grams. This was sustained after the 15th infusion (0.27 grams). During her treatment course with daratumumab, her side effects included transient nausea and vomiting, back pain, and constipation.


The patient had complete remission with proteinuria <0.5 gram and improvement in her kidney function.