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Karanfilovski V, Ristovska V, Gjorgjievski N, Nikolov IG, Dzekova-Vidimliski P, Petrushevska G. Immunotactoid Glomerulopathy: A Rare Glomerular Disease Case Study. Indian J Nephrol 2023; 33:140-143. [PMID: 37234440 PMCID: PMC10208538 DOI: 10.4103/ijn.ijn_107_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/28/2022] [Accepted: 05/13/2022] [Indexed: 11/07/2022] Open
Abstract
Immunotactoid glomerulopathy (ITG) is a rare glomerular disease with variable responsiveness to the immunosuppressive therapy and with uncertain prognosis. ITG was diagnosed in two patients with type 2 diabetes mellitus with nephrotic syndrome and chronic kidney disease. The absence of diabetic retinopathy in the first case and the recent onset of diabetes in the second case accompanied with sudden increase in the 24-hour proteinuria and rapid decline in kidney function, prompted us to perform kidney biopsy. The electron microscopy set the diagnosis of ITG in both cases. There is no consensus for the treatment of ITG. The first patient was treated with combination of steroids and mycophenolate mofetil with reduction of the 24-hour proteinuria, but with persistence of the chronic kidney disease. The second patient received high doses of steroids with continuous deterioration of kidney function with the need of hemodialysis treatment.
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Affiliation(s)
- Vlatko Karanfilovski
- University Hospital of Nephrology, Medical Faculty, Ss. Cyril and Methodius University- Skopje, Republic of North Macedonia
| | - Vesna Ristovska
- University Hospital of Nephrology, Medical Faculty, Ss. Cyril and Methodius University- Skopje, Republic of North Macedonia
| | - Nikola Gjorgjievski
- University Hospital of Nephrology, Medical Faculty, Ss. Cyril and Methodius University- Skopje, Republic of North Macedonia
| | - Igor G. Nikolov
- University Hospital of Nephrology, Medical Faculty, Ss. Cyril and Methodius University- Skopje, Republic of North Macedonia
| | - Pavlina Dzekova-Vidimliski
- University Hospital of Nephrology, Medical Faculty, Ss. Cyril and Methodius University- Skopje, Republic of North Macedonia
| | - Gordana Petrushevska
- Institute of Pathology, Medical Faculty, Ss. Cyril and Methodius University- Skopje, Republic of North Macedonia
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Wang Y, Yan Y, Dong B, Zou W, Li X, Shao C, Jiang L, Wang M, Zuo L. Clinicopathological manifestations of coexistent monoclonal immunoglobulin deposition disease and immunotactoid glomerulopathy. Front Med (Lausanne) 2022; 9:911998. [PMID: 36091681 PMCID: PMC9452626 DOI: 10.3389/fmed.2022.911998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
Combination of monoclonal immunoglobulin deposition disease (MIDD) and immunotactoid glomerulopathy (ITG) is a rare form of monoclonal immunoglobulin (MIg)-associated renal disease. We retrospectively reviewed the native kidney biopsy specimens at Peking University People’s Hospital from 2011 to 2020. Five patients were diagnosed as MIDD + ITG. Their clinical and pathological characteristics were studied. The typical clinical features were nephritic syndrome and renal dysfunction with prominent anemia, but hematuria was mild. Unlike single MIDD and single ITG, on light microscopy, segmentally distributed mesangial nodular sclerosis on the basis of mesangial matrix hyperplasia was the major lesion. Others including membranoproliferative glomerulonephritis (MPGN)-like lesion, glomerular basement membrane thickness, and mild to moderate mesangial and endothelial proliferations might presented at the same time and in the same glomeruli. On immunofluorescence, MIg, usually monoclonal light chains, deposited along glomerular basement membranes and tubular basement membranes, while the intact MIg or monoclonal heavy chain deposited in the mesangial regions. Corresponding to the depositions on immunofluorescence, punctate “powdery” deposits along glomerular basement membranes and tubular basement membranes under electronic microscopy indicated the presence of MIDD. Microtubular substructures (diameters of 20–50 nm) exhibiting hollow cores arranged in parallel arrays in mesangial regions indicated the presence of ITG. Patients treated with bortezomib-based regimen seemed to have better outcomes. In conclusion, MIDD + ITG is a rare combination form of MIg-associated renal disease. Accurate diagnosis requires the comprehensive pathological investigations.
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Affiliation(s)
- Yina Wang
- Department of Nephrology, Peking University People’s Hospital, Beijing, China
| | - Yu Yan
- Department of Nephrology, Peking University People’s Hospital, Beijing, China
- *Correspondence: Yu Yan,
| | - Bao Dong
- Department of Nephrology, Peking University People’s Hospital, Beijing, China
| | - Wanzhong Zou
- Department of Pathology, Peking University Health Science Center, Beijing, China
| | - Xin Li
- Department of Nephrology, Peking University People’s Hospital, Beijing, China
| | - Chunying Shao
- Department of Nephrology, Peking University People’s Hospital, Beijing, China
| | - Lei Jiang
- Electron Microscope Laboratory, Peking University People’s Hospital, Beijing, China
| | - Mei Wang
- Department of Nephrology, Peking University People’s Hospital, Beijing, China
| | - Li Zuo
- Department of Nephrology, Peking University People’s Hospital, Beijing, China
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Takahashi H, Sano T, Kawamura S, Sano K, Miyasaka R, Yamazaki T, Sakakibara M, Abe T, Hashimoto K, Nagaoka M, Kamata M, Naito S, Aoyama T, Moriya R, Takeuchi Y. Long-term clinical course of immunotactoid glomerulopathy complicated with diffuse large B-cell lymphoma. CEN Case Rep 2022; 11:184-190. [PMID: 34569002 PMCID: PMC9061912 DOI: 10.1007/s13730-021-00648-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 09/15/2021] [Indexed: 11/25/2022] Open
Abstract
We report a case of immunotactoid glomerulopathy (ITG) complicated with diffuse large B-cell lymphoma (DLBCL). A 68-year-old woman presented with leg edema and was diagnosed with nephrotic syndrome (NS). Renal biopsy revealed ITG. We treated the patient with prednisolone (20 mg/day) and she achieved complete remission of NS. Steroids were gradually reduced. After 1 year, the patient presented with a breast mass determined on biopsy to be DLBCL. She underwent six cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) therapy. Follow-up revealed complete remission of both DLBCL and ITG. NS recurred after 5 years and she was simultaneously diagnosed with recurrence of DLBCL in bone marrow. She underwent four cycles of R-EPOCH (rituximab, etoposide, prednisolone, vincristine, cyclophosphamide, doxorubicin) therapy and entered remission for DLBCL. NS improved, but the treatment did not lead to remission. After 2 additional years, NS and DLBCL recurred again. She was administered rituximab and NS improved, although proteinuria tended to increase thereafter. One year later, we started prednisolone (10 mg/day), and proteinuria tended to decrease. She is currently undergoing outpatient follow-up. This case suggests that ITG with MGUS should be treated with the possibility of developing malignant hematological disease during the course.
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Affiliation(s)
- Haruka Takahashi
- Department of Nephrology, Kitasato University School of Medicine, Sagamihara, Japan.
| | - Takashi Sano
- Department of Nephrology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Sayumi Kawamura
- Department of Nephrology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Keiko Sano
- Department of Nephrology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Ryoma Miyasaka
- Department of Nephrology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Takuya Yamazaki
- Department of Nephrology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Mayuko Sakakibara
- Department of Nephrology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Tetsuya Abe
- Department of Nephrology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Keiko Hashimoto
- Department of Nephrology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Miki Nagaoka
- Department of Nephrology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Mariko Kamata
- Department of Nephrology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Shokichi Naito
- Department of Nephrology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Togo Aoyama
- Department of Nephrology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Rika Moriya
- Department of Nephrology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yasuo Takeuchi
- Department of Nephrology, Kitasato University School of Medicine, Sagamihara, Japan
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Tuchman SA, Zonder JA. The Spectrum of Monoclonal Immunoglobulin-Associated Diseases. Hematol Oncol Clin North Am 2020; 34:997-1008. [PMID: 33099435 DOI: 10.1016/j.hoc.2020.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The spectrum of immunoglobulin paraprotein-associated diseases requiring therapy extends beyond multiple myeloma and AL amyloidosis. Awareness of these is essential in ensuring timely accurate diagnosis and appropriate treatment. As most paraprotein-associated diseases are fairly uncommon, therapeutic decisions must often be made in the absence of data from randomized controlled trials. Treatment is generally directed at the underlying clonal cell population. This review focuses on the spectrum of the less common paraprotein-associated disorders. In most instances, the monoclonal immunoglobulin plays a direct role in the pathophysiology of the disease course; in a select few, the paraprotein may be a disease marker.
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Affiliation(s)
- Sascha A Tuchman
- Division of Hematology, University of North Carolina - Chapel Hill, Comprehensive Cancer Center, 170 Manning Dr., CB#7305, Chapel Hill, NC 27599, USA
| | - Jeffrey A Zonder
- Barbara Ann Karmanos Cancer Institute/Wayne State University School of Medicine, Myeloma and Amyloidosis Team, Barbara Ann Karmanos Cancer Institute, Detroit, MI, USA.
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