Abstract: SA-PO0795
Rapid Renal Recovery in Proliferative Glomerulonephritis with Monoclonal Immunoglobulin Deposits After Daratumumab-Based Therapy
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
- Ahmed, Ahmed Khalafalla Mohamed, University of Illinois Chicago, Chicago, Illinois, United States
- Amari, Kana R., University of Illinois Chicago, Chicago, Illinois, United States
Introduction
Proliferative Glomerulonephritis with Monoclonal Immunoglobulin Deposits (PGNMID) is a rare monoclonal gammopathy of renal significance characterized by glomerular monoclonal immunoglobulin deposition, often without an identifiable hematologic clone, making treatment challenging.
Case Description
A 61-year-old woman with a history of depression/anxiety presented with progressive edema and worsening kidney function over five months. Laboratory evaluation revealed nephrotic-range proteinuria (UPCR 10.73 g/g), creatinine 5.09 mg/dL (baseline 1.06), hypoalbuminemia, and microscopic hematuria. She was admitted for suspected rapidly progressive glomerulonephritis and treated with pulse steroids. Extensive serologic workup was negative with normal C3/C4. SPEP/UPEP with immunofixation showed no monoclonal protein. Kidney biopsy showed membranoproliferative glomerulonephritis and monoclonal IgG3-kappa deposition, consistent with PGNMID. Bone marrow biopsy showed no detectable clone.
Despite steroids, kidney function worsened with oliguria and peak creatinine of 8.41 mg/dL, requiring two hemodialysis sessions. Empiric plasma cell-directed therapy with daratumumab, cyclophosphamide, bortezomib, and dexamethasone (Dara-CyBorD) was initiated. Marked renal recovery with creatinine improving to 1.3 mg/dL and UPCR decreasing from 10.73 to 2.76 g/g was achieved after the first cycle. Following monthly daratumumab therapy, 24-hour urine protein dropped from 3905 to 558 mg/day (86% reduction), consistent with renal very good partial response.
Discussion
This case highlights the importance of kidney biopsy with IgG subtyping and supports empiric clone-directed therapy in clone-negative PGNMID, where daratumumab-based therapy may achieve substantial renal recovery even in dialysis-requiring disease.
Proteinuria response
Biopsy