Kidney Week

Abstract: TH-PO691

A Postkidney Transplant Patient with Membranous-Like Glomerulopathy with Masked IgG-Kappa Deposits

Session Information

• Glomerular Diseases: Case Reports - 1
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Avila, Paul Brandon, Universidad de San Carlos de Guatemala, Ciudad de Guatemala, Guatemala, Guatemala

Paul Brandon Avila, MD

• Rodriguez Medina, Ulises, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States

Ulises Rodriguez Medina, MD, PhD

• Singh, Pooja P., University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States

Pooja P. Singh, MD, FASN

• Singh, Namita, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States

Namita Singh, MBBS, MD, FASN

• Caza, Tiffany, Arkana Laboratories, Little Rock, Arkansas, United States

Tiffany Caza, MD, PhD

• Garcia, Pablo, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States

Pablo Garcia, MD, FASN

Introduction

Membranous-like glomerulopathy with masked IgG kappa deposits (MGMIDs) is a novel glomerulonephritis —44% of patients experience worsening kidney disease or ESKD. There is no data on long-term post-kidney transplant (KT) outcomes in patients with MGMID. Here, we present a patient with MGMIDs after KT with four years follow-up after diagnosis.

Case Description

A 47 y/o Hispanic male with ESKD due to membranous nephropathy received DDKT without post-KT complications. He developed worsening proteinuria four years after the KT (2.8 g/g). Thus, he underwent a kidney biopsy, which showed MGMID with concurrent IgA nephropathy (M1 E0 S0 T0 C0). No malignancy, no clones and no bone marrow abnormalities were found. After a multidisciplinary team discussion with the patient, he was started on an ACEi and continued immunosuppressive (IS) therapy (tacrolimus, MMF, and prednisone) with no adjustment to his IS therapy. Four years after his diagnosis, his allograft function remains stable, with an eGFR of 109 ml/min and UPCR of 0.2 g/g.

Discussion

MGMID is a complex disease with no easily identifiable clone, lacks established treatment, and has unclear outcomes. Limited data exists for post-KT MGMIDs. This case highlights the disease remission after ACEi and continuation of his IS therapy, indicating that ACEi, MMF and tacrolimus could play a role in the therapeutic approach. Further studies are needed to understand the disease process and guide our management.

A. No significant interstitial fibrosis
B. Glomerulus with mild mesangial expansion
C. Mesangial IgA staining
D. Capillary loop IgG1 staining
E. Mesangial electron dense deposits.
F. Subepithelial electron dense deposits.