PROLIFERATIVE GLOMERULONEPHRITIS WITH MONOCLONAL IMMUNE DEPOSITS (PGNMID), A SHORT SERIES OF 07 CASES IN BANGLADESH

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PROLIFERATIVE GLOMERULONEPHRITIS WITH MONOCLONAL IMMUNE DEPOSITS (PGNMID), A SHORT SERIES OF 07 CASES IN BANGLADESH

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Co-author 1

SK MD Jaynul Islam jaynul.islam@gmail.com International Medical College Pathology Dhaka Bangladesh *

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Introduction

Proliferative glomerulonephritis with monoclonal immune deposits (PGNMID) is a rare entity in which proliferative glomerular changes are seen with IgG/IgM along with kappa or lambda immune deposits. In 2004 Nasr et al first described this unique form of glomerular disease and coined this new nomenclature in the renal pathology. In Bangladesh kappa and lambda have been introduced in the immunofluorescence study recently.

Methods

Results

Here we report 7 cases of PGNMID diagnosed in last one and half year in a renal pathology center in Bangladesh. Among the cases 3 are male and 4 are female with the mean age 41.43 yrs ranging from 28 years to 56 years. Five cases presented with nephrito-nephrotic presentation and two with nephrotic syndrome. The mean serum creatinine level was 2.66 mg/dl ranging from 0.69 to 10.6 mg/dl. Histologically all the cases had membranoproliferative pattern of glomerular changes with marked neutrophilic infiltration and two cases had cellular crescent formation. On immunofluorescence study, 3+ IgG deposition with Kappa restriction was found in 2 cases, 3+ IgG deposition with Lambda restriction was found in 4 cases and 3+ IgM deposits with Lambda restriction was found in one case. In all the cases there was 2+ to 3+ C3 deposition. IgG isotype and electron microscopy was not performed due to unavailability. None of cases had history of plasma cell dyscrasia.

Conclusion

Possibly this is the first case reports on PGNMID in Bangladesh and these could be identified due to introduction of light chains in routine immunofluorescence panel. In contrast to literature, we got more IgG/lambda deposits than IgG/kappa. One case was IgM/lamda type, which is very rare in world literature.

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