Proliferative Glomerulonephritis with Monoclonal Immunoglobulin Deposits: A Case Report

Abstract

Proliferative Glomerulonephritis with Monoclonal Immunoglobulin Deposits (PGNMID) is a relatively rare entity. Patient’s usually present with proteinuria, elevated creatinine, and renal failure. The present case report details the clinical presentation, diagnostic assessments, and treatment outcomes of a 56-year-old female with a complex renal pathology. The patient, with a history of hypertension, presented with generalised anasarca and decreased appetite. Initial examinations revealed pedal oedema, low serum albumin, elevated Blood Urea Nitrogen (BUN), and markedly high serum creatinine levels, indicating impaired kidney function. Further investigations, including urine analysis and immunological tests, identified significant proteinuria and complement system involvement. Radiological studies demonstrated ascites and elevated renal cortical echogenicity. Renal biopsy revealed Proliferative Glomerulonephritis with conventional Monoclonal Immune Deposits-Immunoglobulin G3 (PGNMID-IgG3-kappa). Direct immunofluorescence analysis exhibited a specific staining pattern, confirming the diagnosis. Overall, the diagnostic impression suggested Proliferative Glomerulonephritis with Membranoproliferative Glomerulonephropathy (MPGN) injury pattern, emphasising the complexity of the renal pathology. Despite extensive medical interventions, including haemodialysis and immunosuppressive measures, the patient’s condition deteriorated, leading to a fatal outcome on the 67th day of admission. The present case underscores the challenges in managing advanced renal diseases and emphasises the importance of precise diagnostic methods for guiding targeted therapeutic interventions in such complex cases.

Keywords

• electron microscopy
• immunoglobulin g3-kappa
• myeloproliferative glomerulonephritis