Abstract: SA-PO0762
Successful Treatment of Zanubrutinib in Proliferative Glomerulonephritis with Monoclonal Immunoglobulin Deposits (PGNMID) of B-Cell Clones
Session Information
- Glomerular Diseases: Lupus Nephritis, Monoclonal Gammopathy-Related Disease, and Transplantation
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Teng, Fei, Peking Union Medical College Hospital, Beijing, China
- Zheng, Ke, Peking Union Medical College Hospital, Beijing, China
- Wen, Yubing, Peking Union Medical College Hospital, Beijing, China
- Zhang, Yan, Peking Union Medical College Hospital, Beijing, China
- Li, Xuemei, Peking Union Medical College Hospital, Beijing, China
Introduction
The treatment of PGNMID is a challenge. We present 3 B cell PGNMID cases successfully treated with BTKi, zanubrutinib (ZANU, 160mg bid).
Case Description
Case 1: M/65, diagnosed with CLL by lymph node biopsy, with stable lymphocyte count and renal injury (edema, hematuria, proteinuria, and AKI). Renal biopsy confirmed MPGN with κ-LC restricted deposition, consistent with PGNMID. After 13-month ZANU treatment, SCr 115→107μmol/L, 24hUP 9.05→0.26g, with normalized lymphocyte count.
Case 2: M/73, presented with anemia, generalized lymphadenopathy, renal involvement (hematuria, proteinuria, AKI, HTN). Renal biopsy showed MPGN with IgG2κ deposition; BM biopsy confirmed CLL, without lymphocytosis or splenomegaly. Diagnosed with PGNMID, he was treated with ZANU for 22 months, SCr 317→111 μmol/L, and 24hUP 8.72→2.31g.
Case 3: M/73, presented with purpura, edema, proteinuria, hematuria, AKI, and HTN. Renal biopsy revealed MPGN with IgMκ deposition. Type II cryoglobulinemia was detected; BM biopsy confirmed WM. He was diagnosed with PGNMID and started ZANU. After 2 months, purpura improved, but renal function worsened (SCr 190→263 μmol/L, 24hUP 4.46→13.25 g). Obinutuzumab was added; 6 months of combination therapy reduced SCr to 171 μmol/L and 24hUP to 0.93g.
Discussion
ZANU achieves good renal efficacy in PGNMID of B-cell lymphoproliferative clones; anti-CD20 antibody combination benefits refractory cases.
Baseline characteristics of the three patients
| Patient 1 | Patient 2 | Patient 3 | |
| Gender | Male | Male | Male |
| Diagnostic age, years | 65 | 73 | 73 |
| Disease duration, months | 10 | 10 | 37 |
| Past Medical History | Hypertension | Hypertension, hyperlipidemia, coronary heart disease, nephrolithiasis | Hypertension, diabetes, chronic HBV infection |
| sFLC-κ, mg/L | 68 | 49.9 | 35.6 |
| sFLC-λ, mg/L | 26.9 | 44.2 | 19.9 |
| FLC-κ/λ | 2.528 | 1.129 | 1.789 |
| Renal Ig deposits | κ light chain | IgG2κ | IgMκ |
| Bone marrow involvement | CLL | CLL | WM |
| 24h urine M protein, mg | 23 | 0 | 1.79 |
| 24h urine protein, g | 9.05 | 7.12 | 4.46 |
| Alb, g/L | 31 | 27 | 30 |
| SCr, μmol/L | 108 | 240 | 190 |
| eGFR, ml/min/1.73m^2 | 65.7 | 24.0 | 31.7 |
| C3, g/L | 1.213 | 1.047 | 0.529 |
| C4, g/L | 0.372 | 0.260 | 0.055 |
| IgG, g/L | 5.90 | 5.12 | 1.21 |
Abbreviations: HBV, hepatitis B virus; CLL, chronic lymphocytic leukemia ; WM, Waldenström macroglobulinemia.