Ohio State University Medical Center, Columbus, USA.
Am J Kidney Dis. 2011 Aug;58(2):276-81. doi: 10.1053/j.ajkd.2011.05.003. Epub 2011 Jun 25.
Proliferative glomerulonephritis with monoclonal immunoglobulin G (IgG) deposits (PGNMIGD) is a recently recognized glomerular disease. Light microscopy usually resembles membranoproliferative glomerulonephritis. Glomerular deposits are mostly IgG3 κ; however, unlike in the usual forms of monoclonal immunoglobulin deposition disease, extraglomerular deposits are absent. If PGNMIGD is secondary to the glomerular deposition of circulating monoclonal IgG, it is expected to recur in kidney allografts with the same pattern of monoclonal IgG deposition. We reviewed our kidney biopsy files between January 1, 2003, and January 4, 2010, and identified 21 biopsy specimens with PGNMIGD, mostly with glomerular IgG3 κ deposits. Of the 21 biopsy specimens, 4 were from kidney allografts; 2 were recurrent and the other 2 were de novo diseases. Recurrent PGNMIGD develops rapidly, causing proteinuria. This rapid recurrence of PGNMIGD in kidney allografts provides further proof that PGNMIGD is secondary to the glomerular deposition of circulating monoclonal IgG.
伴单克隆免疫球蛋白 G（IgG）沉积的增生性肾小球肾炎（PGNMIGD）是一种新近认识的肾小球疾病。光镜下通常类似于膜增生性肾小球肾炎。肾小球沉积物主要为 IgG3κ；然而，与常见的单克隆免疫球蛋白沉积疾病不同，无肾小球外沉积。如果 PGNMIGD 继发于循环单克隆 IgG 的肾小球沉积，则预期同种单克隆 IgG 沉积模式的肾移植后会复发。我们回顾了 2003 年 1 月 1 日至 2010 年 1 月 4 日的肾活检文件，共发现 21 例 PGNMIGD 活检标本，主要为 IgG3κ 沉积。在这 21 例活检标本中，有 4 例来自肾移植；2 例为复发，另外 2 例为初发疾病。复发的 PGNMIGD 迅速进展，导致蛋白尿。肾移植中 PGNMIGD 的这种快速复发进一步证明了 PGNMIGD 继发于循环单克隆 IgG 的肾小球沉积。
