Moubarak Simon, Herrera Hernandez Loren P, Cornell Lynn D, Caza Tiffany, Zand Ladan
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota.
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
Kidney Med. 2022 Nov 18;5(1):100575. doi: 10.1016/j.xkme.2022.100575. eCollection 2023 Jan.
Proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID) is the second most common monoclonal gammopathy of renal significance. Rates of progression to kidney failure as well as rates of recurrence after kidney transplantation are high, especially in the absence of treatment. Treatment is usually targeted toward the abnormal clone, but even in the absence of an identifiable clone, empiric treatment is still recommended to avoid worsening prognosis. In this report, we present an unusual course of a PGNMID case with a relapsing and remitting pattern of illness, likely triggered by infection and vaccination. The patient in this case showed subsequent improvement after each episode, with stable kidney function over the years. This case report highlights the importance of investigating possible recent infectious exposures or vaccinations as potential triggers for this disease. This association should be considered for future patients with PGNMID, especially when there is no identifiable clone to help guide therapy.
伴单克隆免疫球蛋白沉积的增殖性肾小球肾炎（PGNMID）是第二常见的具有肾脏意义的单克隆丙种球蛋白病。进展至肾衰竭的比率以及肾移植后的复发率都很高，尤其是在未接受治疗的情况下。治疗通常针对异常克隆，但即使在没有可识别克隆的情况下，仍建议进行经验性治疗以避免预后恶化。在本报告中，我们呈现了一例PGNMID病例的不寻常病程，其病情呈复发缓解模式，可能由感染和疫苗接种引发。该病例患者在每次发作后均有改善，多年来肾功能稳定。本病例报告强调了调查近期可能的感染暴露或疫苗接种作为该疾病潜在触发因素的重要性。对于未来的PGNMID患者应考虑这种关联，尤其是在没有可识别克隆来指导治疗时。
