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Proliferative glomerulonephritis with monoclonal immunoglobulin deposits: an entity associated with distinct diseases and comparison between IgG1 and IgG3 subtypes

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Abstract

Objectives

The aim of the study was to investigate the clinicopathological characteristics and prognosis of proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID) and determine the differences between PGNMID associated with extrarenal disease and without clear etiology as well as the differences between IgG1 and IgG3 subtypes.

Methods

Data from 46 patients with PGNMID observed from January 2014 to September 2021 in Peking University First Hospital were retrospectively analyzed, including 36 patients without clear etiology (Group A) and 10 patients with extrarenal disease (Group B).

Results

At presentation patients showed proteinuria (95.7%), hematuria (89.1%), renal insufficiency (73.9%), and hypocomplementemia of C3 or C4 (35.6%). Monoclonal immunoglobulin or cell clones were detected in 22.2% of patients (10/45). The monoclonal immunoglobulins deposited in kidney were IgG3 in 40 patients, IgG1 in 5, and IgM in one. Monoclonal IgG1 deposits were more common in Group B than in Group A (4/10 vs. 1/36, p = 0.006). The intensity of glomerular C3 deposition and the frequency of subendothelial deposits in IgG3 subtype were significantly higher than those in IgG1 subtype. During a median follow-up time of 12.2 (range 1–61) months, a higher level of serum creatinine at biopsy and a higher percentage of global glomerulosclerosis were independent predictors of end-stage kidney disease.

Conclusions

PGNMID associated with extrarenal disease was more likely to have monoclonal IgG1 deposits. PGNMID of IgG3 subtype differs from IgG1 subtype by higher intensity of glomerular C3 deposition and higher frequency of subendothelial deposits. Serum creatinine and global glomerulosclerosis were independent prognostic predictors of ESKD in PGNMID.

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Acknowledgements

We would like to thank the patients for their participation in this study.

Funding

This study was supported by grants from the National Natural Science Foundation of China (No. 82070747).

Author information

Authors and Affiliations

  1. Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China

    Mengyao Liu, Xiaojuan Yu, Suxia Wang, Aibo Qin, Fude Zhou & Minghui Zhao

  2. Institute of Nephrology, Peking University, Beijing, China

    Mengyao Liu, Xiaojuan Yu, Suxia Wang, Aibo Qin, Fude Zhou & Minghui Zhao

  3. Renal Pathology Center, Institute of Nephrology, Peking University, Beijing, China

    Mengyao Liu, Xiaojuan Yu, Suxia Wang, Aibo Qin, Fude Zhou & Minghui Zhao

  4. Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China

    Mengyao Liu, Xiaojuan Yu, Suxia Wang, Aibo Qin, Fude Zhou & Minghui Zhao

  5. Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China

    Mengyao Liu, Xiaojuan Yu, Suxia Wang, Aibo Qin, Fude Zhou & Minghui Zhao

  6. Laboratory of Electron Microscopy, Pathological Centre, Peking University First Hospital, Beijing, 100034, People’s Republic of China

    Suxia Wang

  7. Peking-Tsinghua Center for Life Sciences, Beijing, 100034, People’s Republic of China

    Minghui Zhao

Authors
  1. Mengyao Liu
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  2. Xiaojuan Yu
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  3. Suxia Wang
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  4. Aibo Qin
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  5. Fude Zhou
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  6. Minghui Zhao
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Contributions

ML contributed to the study design, data collecting and analysis, and draft of the manuscript; XY reviewed the renal pathologies and interpreted the pathological data; SW reviewed the renal pathologies. AQ collected the data; FZ designed, supervised the study, reviewed and edit the manuscript; MZ reviewed and edit the manuscript. All authors approved of submitting the manuscript for publication.

Corresponding author

Correspondence to Fude Zhou.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

This study was performed in accordance with the Helsinki Declaration, and was approved by the ethics committee of the Peking University first hospital.

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Written informed consent were obtained from the patient.

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Cite this article

Liu, M., Yu, X., Wang, S. et al. Proliferative glomerulonephritis with monoclonal immunoglobulin deposits: an entity associated with distinct diseases and comparison between IgG1 and IgG3 subtypes. J Nephrol 35, 2363–2372 (2022). https://doi.org/10.1007/s40620-022-01317-w

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  • DOI: https://doi.org/10.1007/s40620-022-01317-w

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