Case reportRenalA Case of Recurrent Immunotactoid Glomerulopathy in an Allograft Treated With Rituximab
Section snippets
Case Report
A 56-year-old female with end-stage renal disease secondary to ITG received a cadaveric kidney transplant. She had a past medical history of fibromyalgia, osteoarthritis, asthma, gastroesophageal reflux disease (GERD), hypertension, and monoclonal gammopathy of undetermined significance (MGUS). Postoperatively she was placed on a triple regimen of tacrolimus, mycophenolate mofetil (MMF), and prednisone. Seven weeks after transplantation her serum creatinine level increased to 1.3 mg/dL from a
Discussion
Patients with ITG generally present with proteinuria, usually marked, and associated nephrotic syndrome and hematuria.2 The mean age of these patients is in their sixties.3 There is a relationship with lymphoproliferative disorders in patients who exhibit this type of renal disease.4 By light microscopy, mesangial or diffuse proliferative patterns are the most commonly recognized. Congo red stain is always negative. By immunofluorescence, coarse deposits of IgG and C3, either mesangial or
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Cited by (18)
Monoclonal Gammopathy–Related Kidney Diseases
2022, Advances in Chronic Kidney DiseaseCitation Excerpt :Various immunosuppressive regimens have been used, including corticosteroid monotherapy and chemotherapy with rituximab, bortezomib, an alkylating agent, or an antimetabolite.32,38 Recurrence of ITG in the kidney allograft is common (around 50-60%), occurring within a few weeks to several months after transplantation, and often leads to allograft failure.32,38,39 Recurrence depends on the status of the underlying hematologic disorder prior to transplantation.
Monoclonal gammopathy of renal significance: Early diagnosis is key
2021, NefrologiaCitation Excerpt :Thus, treatment from early stages has a great impact on the prognosis of renal and patient survival.11 It is important to emphasize that kidney transplantation in patients with MGRS without previous treatment may present a significant risk of renal allograft loss due to disease recurrence, since the mechanism of the lesion remains in full activity.25 For this reason, treatment should also be considered in those patients who are candidates to receive a kidney transplant, since in this case complete remission of the hematologic disease may prevent subsequent recurrence in the renal transplant.26
Results of a nation-wide cohort study suggest favorable long-term outcomes of clone-targeted chemotherapy in immunotactoid glomerulopathy
2021, Kidney InternationalCitation Excerpt :In patients with low probability of renal recovery, chemotherapy should be proposed only to those eligible for renal transplantation to preserve long-term allograft function.10 Recurrence of ITG occurs in ∼50% of patients, sometimes within a few weeks after transplantation, and often leads to graft loss.3,33–35 In our series, among 2 transplanted patients with MGRS-associated ITG, 1 experienced biopsy-proven recurrence at 4 years, with degradation in allograft function and nephrotic-range proteinuria.
Immunotactoid glomerulopathy is a rare entity with monoclonal and polyclonal variants
2021, Kidney InternationalCitation Excerpt :As noted previously, 2 of the 3 patients had polyclonal ITG in the native kidney that recurred as monoclonal ITG in the allograft, suggesting fluidity between these groups. The remaining patient, similar to previous case reports,11-13 had monoclonal ITG in both the native kidney and the transplanted kidney. The latter patient achieved CR after chemotherapy for CLL, showing that clone-directed therapy can improve outcomes in recurrent monoclonal ITG, similar to monoclonal ITG in the native kidney.
The Spectrum of Monoclonal Immunoglobulin-Associated Diseases
2020, Hematology/Oncology Clinics of North AmericaCitation Excerpt :This is in contrast to amyloid fibrils that have a more mesangial predominance and an average diameter of 7 to 13 nm. There are numerous reports of cases of IGN being treated with steroids or immunosuppressive therapy, including rituximab.33–35 There is also at least one published case report in which a patient was successfully treated with ASCT.36
Recurrent Severe Acute Kidney Injury From Immunotactoid Glomerulonephritis and Response to Rituximab
2021, American Journal of Therapeutics