Abstract | BACKGROUND: CASE PRESENTATION: A 75-year-old man presented with progressive leg edema, had nephrotic range proteinuria, hypoalbuminemia, moderate renal failure, and occult blood in his urine. Electrophoresis results showed serum and urinary monoclonal spikes of IgGκ type immunoglobulin. A renal biopsy specimen showed lobular mesangial proliferation with mesangiolysis, glomerular micro- aneurysm, and endocapillary hypercellularity. Immunofluorescence results revealed strong granular capillary and mesangial staining for IgG1, C3 and κ light chain in glomeruli without tubular deposits of any immunoglobulin. Electron microscopy also showed dense granular deposits in subendothelial and mesangial areas. PGNMID associated with multiple myeloma (IgGκ type) was diagnosed on the basis of a subsequent bone marrow examination. Bortezomib and dexamethasone therapy significantly reduced proteinuria and elevated serum albumin level. Eight months later, the second renal biopsy showed no active lesions and that the IgG1 and κ light chain deposits had drastically disappeared. CONCLUSIONS: This is the first case of PGNMID with multiple myeloma successfully treated with bortezomib and dexamethasone in which comparative renal biopsies were performed before and after treatment. Our findings suggest the pathogenesis of PGNMID and therapeutic options for PGNMID.
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Authors | Rio Noto, Nozomu Kamiura, Yuichiro Ono, Sumie Tabata, Shigeo Hara, Hideki Yokoi, Akihiro Yoshimoto, Motoko Yanagita |
Journal | BMC nephrology
(BMC Nephrol)
Vol. 18
Issue 1
Pg. 127
(04 06 2017)
ISSN: 1471-2369 [Electronic] England |
PMID | 28385149
(Publication Type: Case Reports, Journal Article)
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Chemical References |
- Antibodies, Monoclonal
- Antineoplastic Agents
- Glucocorticoids
- Immunoglobulin G
- Bortezomib
- Dexamethasone
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Topics |
- Aged
- Antibodies, Monoclonal
- Antineoplastic Agents
(therapeutic use)
- Bortezomib
(therapeutic use)
- Dexamethasone
(therapeutic use)
- Glomerulonephritis, Membranoproliferative
(drug therapy, etiology, immunology)
- Glucocorticoids
(therapeutic use)
- Humans
- Immunoglobulin G
(immunology)
- Male
- Multiple Myeloma
(complications, drug therapy, immunology)
- Treatment Outcome
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