Abstract: SA-PO0819
Effect of Clonal-Directed Therapy on Outcomes in Proliferative Glomerulonephritis with Monoclonal Immunoglobulin Deposits: A Retrospective Cohort Study
Session Information
- Glomerular Management: Real-World Lessons and Emerging Therapies
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Jaturapisanukul, Solos, Navamindradhiraj University, Bangkok, Thailand
- Nasr, Samih H., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Leung, Nelson, Mayo Clinic Minnesota, Rochester, Minnesota, United States
Background
Proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID) is a rare glomerular disease within the spectrum of monoclonal gammopathy of renal significance. Because most PGNMID patients do not have an identifiable clone, the use of clonal-directed therapy (CDT) is challenging.
Methods
A retrospective review of PGNMID cases treated at the Mayo Clinic categorized patients into 3 groups based on their initial treatment. The CDT group included those who received CDT with a detectable clone or monoclonal protein. The non-CDT group included patients treated empirically without evidence of monoclonal protein, or those with detectable monoclonal protein who received other immunosuppression. The supportive group consisted of patients managed without immunosuppressive therapy.
Results
Of the 74 patients, 14 were in the CDT group, 51 - non-CDT group, and 9 - supportive group. Twenty (27%) patients had a detectable clone or monoclonal protein. The supportive group had lower baseline proteinuria compared to the CDT and non-CDT groups (median 0.9 vs. 5.6 and 5.0 g/day, respectively; p = 0.016). Kidney response to first-line treatment was 76.9% of CDT patients vs. 36.0% in the non-CDT group (p = 0.012). Among 17 patients who received second-line clonal-directed therapy, the kidney response rate was 70.6%. No significant difference in death-censored kidney survival among the 3 groups (p = 0.86).
Conclusion
The CDT group showed higher kidney response rates, although long-term kidney survival did not differ significantly. Second-line therapy in patients initially treated empirically without detectable monoclonal protein was effective, suggest that empirical clonal-directed therapy may benefit selected patients and can be adjusted after initial treatment failure.