Recurrence of monoclonal IgA lambda glomerulonephritis in kidney allograft associated with multiple myeloma

Abstract

Proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID) has been described as a new entity resembling immune-complex glomerulonephritis (GN). The recurrence of proliferative GN with monoclonal IgG in the renal allograft has been reported. However, recurrence of proliferative GN with monoclonal IgA after renal allograft is undefined. We previously reported a case of a 35-year-old woman with proliferative glomerulonephritis with monoclonal lambda (λ) with mesangial and subendothelial paracrystalline deposits in the native kidney and initially undetectable circulating monoclonal protein or clone by bone marrow biopsy or flow cytometry. Despite immunosuppressive therapy, her renal disease progressed to end-stage of renal disease (ESRD) and the patient ultimately received a renal allograft. Transplantation was followed by recurrence of IgA-λ PGNMID 4 months after renal transplantation and was associated the diagnosis of multiple myeloma. To the best of our knowledge recurrence of IgA PGNMID with paracrystalline deposits has not been previously reported.