Membranous-Like Glomerulopathy with Masked Monoclonal Deposits in a Patient with Class 5 Lupus Nephritis: A Case Report
- Glomerular Diseases: Podocyte Biology - II
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1403 Podocyte Biology
- Alkhulaifawi, Mohammed NH, Prolato Clinical Research Center, Houston, Texas, United States
Membranous-like glomerulopathy with masked IgG kappa (k) deposits is a pattern of immune complex deposition characterized by masked deposits that show IgG k restriction and are subepithelial and mesangial by electron microscopy. We present a case of a patient with SLE and biopsy-proven class 5 lupus nephritis whose repeat biopsy showed MMMD.
A 26-year-old Hispanic female was admitted for the evaluation of persistent proteinuria. She was diagnosed with systemic lupus erythematosus (SLE) in 2015 and underwent a kidney biopsy in 2019 for proteinuria >1g that return with positive dsDNA, anticardiolipin antibody (IgG and IgM), and low C4. Initial biopsy was reported as “Membranous Glomerulonephritis consistent with class 5 Lupus Nephritis. The IgA was Glomeruli with focal segmental trace peripheral granular staining, IgG was Glomeruli with diffuse and global, peripheral granular staining 3+, IgM was Glomeruli with diffuse, segmental to global, mesangial, and peripheral granular staining 2+, C3 was Glomeruli with focal and segmental weak peripheral staining, arterioles +, C1q was Glomeruli with diffuse and global, peripheral granular staining 1+ to 2+. She volunteered to participate in a clinical trial for lupus nephritis in mid-2023, her labs were positive for dsDNA, low C4, and proteinuria >1g. FLC ratio indicates that Kappa and Lambda Glomeruli with diffuse and global, peripheral granular staining 3+, tubular protein droplets are positive, the second renal biopsy was done at this visit that reported as Membranous Glomerulonephritis, consistent with Lupus Class V Given the new finding of MMMD, a search for monoclonal gammopathy was initiated looking for flow cytometry, the serum protein electrophoresis (SPEP), and serum-free light chains, all of which were reported as negative (see table). Given the negative workup for Monoclonal gammopathy/MGRS, the MMMD was considered secondary to lupus nephritis, a rarely reported renal manifestation of Lupus Nephritis. She is currently on Mycophenolate, Hydroxychloroquine, Lisinopril, and Hydrochlorothiazide, based on recent lab results there is no significant improvement in her proteinuria.
In conclusion, patients with SLE can develop Membranous glomerulonephritis with masked monoclonal deposits as a renal manifestation of the SLE in addition to classic class 5 lupus nephritis.