Abstract: SA-PO851
Double Jeopardy: Monoclonal Gammopathy of Renal Significance (MGRS) in the Shadow of Lupus Nephritis
Session Information
- C3G, TMA, MGRS, Amyloidosis, and More
October 26, 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
- Mouawad, Yara, The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, Texas, United States
- Tchakarov, Amanda, The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, Texas, United States
- Waguespack, Dia Rose, The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, Texas, United States
Introduction
Monoclonal gammopathy of renal significance remains a clinical challenge given the rarity of the condition and lack of literature regarding treatment and outcomes.
Case Description
This is the case of a 56 year old female with diagnosed APLS, SLE, and cryoglobulinemia. Her disease course was complicated by multiple thrombotic events requiring adjustment of her anticoagulation. She had quiescent disease, and was off treatment except for anticoagulation, when work up showed a rising creatinine, elevated dsDNA titers, and hematuria. A renal biopsy was considered to be high risk given her anticoagulation and thrombocytopenia, therefore she was assumed to have lupus nephritis and was started on Plaquenil, prednisone and later azathioprine. Despite treatment, she had worsening proteinuria up to nephrotic levels. She was switched to mycophenolate, however was unable to tolerate it. At the same time, she complained of a worsening rash on her lower extremities. A renal biopsy was then performed which revealed "Proliferative Glomerulonephritis with Monoclonal IgG Deposits, specifically IgG kappa restricted deposits”. The biopsy did not show evidence of lupus nephritis, APLS or cryoglobulinemic vasculitis. She initially had a normal SPEP and a bone marrow biopsy was normal ruling out any hematological malignancy, MGUS, or MM. Repeat SPEP showed an IgG kappa monoclonal band consistent with deposits seen on renal biopsy. Given the lack of data on treatment of monoclonal gammopathy of renal significance in patients with underlying autoimmune diseases, the decision was made to treat with Rituximab as a clone depleting agent.
Discussion
This case highlights the importance of considering monoclonal gammopathy of renal significance as a cause of glomerulonephritis, particularly in patient with SLE despite its rarity.