Abstract: TH-PO0902
Proliferative Glomerulonephritis with Monoclonal Immunoglobulin G Deposits (PGNMID) After Kidney Transplantation: A Case Series
Session Information
- Transplantation: Clinical - Glomerular Diseases, Infections, and Rejection
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Oseguera, Mayra A., The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
- Pesavento, Todd E., The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
- Singh, Priyamvada, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
Introduction
PGNMID is a rare form of monoclonal gammopathy of renal significance (MGRS). It is renal-limited and results from deposition of immunoglobulins, particularly IgG3 kappa in the glomeruli. The pathogenesis of PGNMID remains unclear, and it has a high recurrence and graft loss rate in kidney transplant recipients (KTRx).
Case Description
We conducted a single-centered, retrospective chart review of adult KTRx with a history of PGNMID from 2010 to 2023. Twelve patients with a total of 21 transplant episodes were included. Median age was 34 [28, 44] years, 57% were male and 67% were Caucasian. 43% received a living donor and 57% received a deceased donor transplant. 71% had a diagnosis of PGNMID/MPGN in the native kidney, and the rest had de novo disease post-transplant. Out of 12, six KTRx were on their first transplant, and three each were on their second and third transplant. A 62% (13/21) graft loss was seen. The median time to diagnosis was two years, but the earliest recurrence was reported within two months. The median time for graft loss was four years (1, 9). Of these, 9/13 were lost due to PGNMID, and 4/13 were lost due to rejection (Acute cell-mediated rejection, Banff 1A-2B). All patients were alive at the time of the study. 6/21 had CMV viremia requiring treatment, 5/21 had BK viremia of > 10K. Only two patients had a minute amount of cell dyscracia involvemnt on bone marrow biopsy, and two had clonality on serum immunofixation. Treatment targets the clonal proliferation of the identified B or plasma cells but is unclear in cases without an identifiable clone. Three patients underwent an autologous stem cell transplant, and one had recurrence despite the ASCT. Depending on the oncologist's preference, the treatment options used were bortezomib, rituximab, and daratumumab.
Discussion
Protocol or early biopsy in patients with known PGNMID is recommended. Monitoring disease progression is a challenge; urine protein/creatinine ratio and creatinine are late markers. Most cases have no clonality; thus, kidney biopsy remains the gold standard for diagnosis. Duration and withdrawal of treatment are unknown areas, and more research is warranted. ASCT has unknown benefits, especially in absence of clonality. Further studies and registries are needed to develop evidence-based treatment options for this rare disease.