Abstract:

A 30y female with unidentifiable cause of renal failure presented with abnormal urinary dipstick test for 4 months postkidney transplantation.The nadir serum creatinine of this patient was within normal range and the dosage of  immunosuppressive agents was reduced due to low leukocyte count.Six months after the surgery,abnormal urine dipstick and panelreactive antibody positivity occurred.An initial allograft biopsy indicated acute antibodymediated rejection and methylprednisolone pulse therapy was initiated.Serum creatinine level returned to normal range while urine dipstick test was still abnormal.A repeat allograft biopsy at our institute revealed proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID,IgG3λ type) in addition to acute antibodymediated rejection,which were treated with methylprednisolone pulse therapy,intravenous immunoglobulin and bortezomib were administered.Proteinuria remission and normal serum creatinine level were achieved after this treatment protocol.

Key words: renal transplantation, proliferative glomerulonephritis with monoclonal IgG deposits, acute antibody-mediated rejection