Rituximab-Induced Remission in Proliferative Glomerulonephritis with Monoclonal Immunoglobulin G Deposits: A Case Report with Serial Kidney Biopsies

Certificate Output Instructions

For best output, select "Paper Size" as "A4" and "Margin" as "0" or "None".

To save or print to PDF, please select Print Destination > Save as PDF, enable Background Graphics under "More Settings", then click "Save".

Presented the abstract " "
(Abstract co-author(s): )

Back

E-Poster Presentation

During the congress, E-Posters will be accessible to all participants on the congress website 24/7, as well as in the E-poster stations in the congress center.

Preparing your E-Poster

Please review the E-Poster format requirements carefully when preparing your E-Poster. Should your E-Poster not meet the mentioned requirements, it may not be displayed as described above.

E-Poster Submission Deadline

Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.

E-Poster Format Requirements

PDF file
Layout: Portrait (vertical orientation)
One page only (Dim A4: 210 x 297mm or PPT)
E-Poster can be prepared in PowerPoint (one (1) PowerPoint slide) but must be saved and submitted as PDF file.
File Size: Maximum file size is 2 Megabytes (2 MB)
No hyperlinks, animated images, animations, and slide transitions
Language: English
Include your abstract number
E-posters can include QR codes, tables and photos

E-Poster

Abstract Title *

Rituximab-Induced Remission in Proliferative Glomerulonephritis with Monoclonal Immunoglobulin G Deposits: A Case Report with Serial Kidney Biopsies

Please follow the instructions below to input your abstract title.

Abstract titles should be brief and reflect the content of the abstract.

The title will not be accepted if it exceeds 25 words.
Type in CAPITAL LETTERS.
Lowercase may be used for abbreviations only, for example, mRNA.

Co-author 1

Min-Gyu Kim

Co-author 2

Ji-Eun Yoo

Co-author 3

Yu-Kyung Chung

Co-author 4

Jang-Hee Cho

Co-author 5

Yong-Jin Kim

Co-author 6

Co-author 7

Co-author 8

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

Proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) is a rare form of monoclonal gammopathy of renal significance (MGRS). The natural history and optimal treatment are poorly defined, particularly when circulating monoclonal proteins or hematologic clones are undetectable. We report a 57-year-old woman with biopsy-confirmed PGNMID who underwent three sequential kidney biopsies.

Methods

Results

Case Presentation A 57-year-old woman presented with nephrotic-range proteinuria (10.4 g/day), microscopic hematuria, and impaired renal function (Cr 1.4 mg/dL). She had hypertension but no systemic disease or detectable monoclonal protein. The first biopsy showed membranoproliferative glomerulonephritis with diffuse mesangial hypercellularity, strong IgG/C3/C1q staining, and kappa restriction. EM revealed abundant subendothelial deposits. Bone marrow biopsy was negative. She received high-dose steroids, then mycophenolate mofetil, with partial reduction of proteinuria (to 1.2 g/g) but later developed anuria and worsening kidney function (Cr 2.7 mg/dL), requiring hemodialysis. The second biopsy again showed MPGN with increased deposits, early crescent formation, and new interstitial inflammation. Despite steroids and cyclophosphamide, renal failure persisted. Rituximab (500 mg ×2) was then given. Urine output and renal function gradually recovered, and dialysis was discontinued. The third biopsy demonstrated marked improvement: mesangial hypercellularity resolved, deposits disappeared on EM, and IF was negative for IgG and kappa restriction. Only mild chronic changes remained. At 24 months, renal function was stable (Cr 1.0 mg/dL; UPCR 0.9 g/g).

Conclusion

Histologic assessment can reveal ongoing disease activity in PGNMID even when conventional clinical markers such as proteinuria or serum creatinine suggest stability. Serial renal biopsies can guide therapeutic decisions and may help identify patients who would benefit from early clone-directed therapy. Complete clinical and histologic remission after rituximab, despite the absence of detectable monoclonal protein or a hematologic clone, supports a pathology-driven, individualized treatment strategy in PGNMID.

Kewords