Abstract: FR-PO1155
De Novo Proliferative Glomerulonephritis with Monoclonal IgG Kappa Deposits in a Kidney Transplant Recipient: Complete Histologic Remission with Daratumumab
Session Information
- Transplantation: Clinical - Transplant Access, Recipient Evaluation, Living Donors, Pregnancy, and More
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Jayeola, Olakunle A., The University of New Mexico Department of Internal Medicine, Albuquerque, New Mexico, United States
- Garcia, Pablo, The University of New Mexico Department of Internal Medicine, Albuquerque, New Mexico, United States
- Singh, Namita, The University of New Mexico Department of Internal Medicine, Albuquerque, New Mexico, United States
- Argyropoulos, Christos, The University of New Mexico Department of Internal Medicine, Albuquerque, New Mexico, United States
- Caza, Tiffany, Arkana Laboratories, Little Rock, Arkansas, United States
- Singh, Pooja P., The University of New Mexico Department of Internal Medicine, Albuquerque, New Mexico, United States
Introduction
Proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID) is a rare form of monoclonal gammopathy of renal significance (MGRS). De novo PGNMID in renal allografts is poorly characterized, with management complicated by existing immunosuppression and frequently undetectable circulating clones. We present a case of de novo allograft PGNMID achieving complete histologic remission with daratumumab.
Case Description
A 67-year-old woman with end-stage kidney disease (ESKD) attributed to type 2 diabetes mellitus, status post deceased-donor kidney transplant (DDKT), underwent allograft biopsy for rising serum creatinine and proteinuria nine months post-transplant. Histopathology revealed proliferative glomerulonephritis with monoclonal IgG3 kappa deposits (Fig A-B). Bone marrow biopsy, serum protein electrophoresis, and serum free light chain assays did not identify a circulating clone. A repeat allograft biopsy confirmed persistent PGNMID, and daratumumab was initiated. Following six cycles of daratumumab, serum creatinine improved from 2.27 to 1.28 mg/dL and proteinuria decreased from 1.19 to 0.07 g/g. Repeat allograft biopsy at 6 months post-treatment demonstrated complete resolution of monoclonal deposits with no residual proliferative changes (Fig C-D), consistent with complete histologic remission.
Discussion
This case illustrates de novo PGNMID in renal allografts is a likely underrecognized entity given low rates of detectable circulating clones. Importantly, it demonstrates daratumumab can achieve complete histologic remission even in the absence of an identifiable clone and in the context of concurrent transplant immunosuppression. These findings support the expanding role of clone-directed therapy in MGRS-related allograft disease and underscore the need for prospective studies to further define optimal treatment strategies.