Abstract: PUB236
A Rare Case of Immunotactoid Glomerulopathy and T Cell Lymphoma in a Kidney Transplant Recipient
Session Information
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Khater, Abdarrhman, Stony Brook Medicine, Stony Brook, New York, United States
- Ali, Selma, Stony Brook Medicine, Stony Brook, New York, United States
- Kaur, Navdeep, Stony Brook Medicine, Stony Brook, New York, United States
- Hennigar, Randolph Alexander, Stony Brook Medicine, Stony Brook, New York, United States
Introduction
Immunotactoid glomerulonephritis (ITG) is a rare glomerular disease characterized by microtubular immune deposits, and typically associated with B-cell lymphoproliferative disorders. Here we present a case of late recurrence of ITG in a kidney allograft associated with T-cell lymphoma. Only a handful of cases of ITG with T-cell lymphoma have been reported in the literature [1–3].
Case Description
A 65-year-old man with end stage kidney disease due to biopsy proven ITG in 2007 and a deceased donor kidney transplant in 2013 presented with nephrotic syndrome. He had stable allograft function for over 10 years, but then presented with a drop in albumin, rise in creatinine to 2.5 mg/dl from baseline of ~ 1.8 mg/dl and 5 g of proteinuria by random urine protein to creatinine ratio. A transplant kidney biopsy was done and revealed ITG with a membranous pattern, co-dominant IgA and C3 deposits, kappa light chain restriction, and Banff grade 3 interstitial fibrosis and tubular atrophy. His donor specific antibodies were negative. There was no histologic evidence of B- or T-cell mediated rejection.
His history included stage III-A peripheral T-cell lymphoma which was treated in 2021. Patient declined bone marrow biopsy. He was otherwise up to date with age-appropriate cancer screening. Patient’s kidney function continued to decline and is approaching end stage kidney disease. He has opted not to do dialysis and pursue conservative management.
Discussion
While ITG is most often associated with B-cell lymphomas, this case adds to a small but growing body of literature suggesting it can also occur in patients with T-cell malignancies [1–3]. Given association with hematological disorders, bone marrow biopsy would be part of the work up to rule out monoclonal gammopathy of renal significance and multiple myeloma. He had no evidence of recurrence of T-cell lymphoma. This case highlights a late recurrence of ITG in a kidney allograft associated with T-cell lymphoma.
References
1 Nagaharu K, et al. A Rare Case of Immunotactoid Glomerulopathy Associated with Hodgkin Lymphoma. Case Rep Nephrol. 2021;2021:5527966.
2 Nasr SH, et al. Monoclonal gammopathy–associated glomerulopathy in the transplant setting. Clin J Am Soc Nephrol. 2019;14(9):1371–1382
3 Abramson M, Shaikh A. Immunotactoid Glomerulopathy. Adv Kidney Dis Health. 2024 Jul;31(4):326-333.