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Proliferative glomerulonephritis with monoclonal IgG kappa deposits  
A 50-year-old man presents with rapidly progressive glomerulonephritis (RPGN) requiring dialysis. Creatinine is 2.4 and rising. A kidney biopsy demonstrates proliferative glomerulonephritis with monoclonal IgG kappa deposits (PGNMID). Interstitial fibrosis tubular atrophy (IFTA) is 10%. Pulse steroid therapy is performed and after a full paraprotein work-up no monoclonal protein is detected in blood or urine. A bone marrow aspirate and trephine biopsy (BMAT) shows no lymphocyte or plasma cell clonal population. No lymphadenopathy is present. How do you target a clone when no clone is found: bortezomib, rituximab or even daratumumab? Share your thoughts. 

Summary provided by Roger Rodby, MD, FASN.
Previous Community Minded Summaries are available at: https://community.asn-online.org/browse/communityminded