Daratumumab combined with cyclophosphamide in the treatment of proliferative glomerulonephritis with monoclonal immunoglobulin deposits: a case report
10.3760/cma.j.cn441217-20240315-00317
- VernacularTitle:达雷妥尤单抗联合环磷酰胺治疗伴单克隆免疫球蛋白沉积的增生性肾小球肾炎1例
- Author:
Fengping QIU
1
;
Liangliang CHEN
;
Fanghao CAI
;
Qin ZHOU
;
Jianghua CHEN
;
Fei HAN
Author Information
1. 浙江大学医学院附属第一医院肾脏病中心，浙江大学肾脏病研究所，浙江省肾脏病防治技术研究重点实验室，杭州 310003
- Keywords:
Paraproteinemias;
Glomerulonephritis, membranoproliferative;
Cyclophosphamide;
Daratumumab;
Monoclonal immunoglobulin;
Proliferative glomerulonephritis
- From:
Chinese Journal of Nephrology
2024;40(8):663-667
- CountryChina
- Language:Chinese
-
Abstract:
This article reports a rare case of proliferative glomerulonephritis with monoclonal immunoglobulin deposits. The patient, a middle-aged woman, exhibited clinical manifestations including nephrotic syndrome, microscopic hematuria, renal insufficiency, hyperglycemia, and bilateral diabetic retinopathy. Notably, monoclonal bands were absent in both blood and urine immunofixation electrophoresis. Renal biopsy revealed membranoproliferative glomerulonephritis, with immunofluorescence revealing exclusive petal-like deposition of IgG3 subtype along the capillary loop. Electron microscopy demonstrated segmental thickening of the glomerular basement membrane, along with electron dense deposits in the subendothelial and mesangial areas, lacking discernible substructure. The diagnosis comprised proliferative glomerulonephritis with monoclonal immunoglobulin deposition concurrent with diabetic nephropathy. Subsequent sequential treatment with daratumumab and cyclophosphamide over 6 months led to partial remission of nephrotic syndrome, normalization of renal function, and significant improvement of anemia. During the 24-month follow-up period, no serious adverse reactions occurred.
