From the Guidelines
The treatment of IgG3 kappa glomerulonephritis should involve immunosuppressive therapy, including corticosteroids and additional immunosuppressants, with the goal of preventing disease progression and minimizing harmful side effects from immunosuppression, as recommended by the KDIGO 2021 guideline for the management of glomerular diseases 1.
Treatment Approach
The treatment approach for IgG3 kappa glomerulonephritis typically involves:
- Initial therapy with corticosteroids, such as prednisone at 1 mg/kg/day (maximum 60-80 mg daily) for 4-6 weeks, followed by a slow taper over 3-6 months
- Combination with an additional immunosuppressant, such as cyclophosphamide (2 mg/kg/day orally or 0.5-1 g/m² IV monthly) or rituximab (375 mg/m² weekly for 4 weeks)
- Supportive care, including blood pressure control with ACE inhibitors or ARBs targeting <130/80 mmHg, sodium restriction (<2 g/day), and proteinuria management
Monitoring and Adjustment
Treatment response should be monitored through regular assessment of kidney function, proteinuria, and hematuria every 2-4 weeks initially, and the treatment regimen should be adjusted as needed to prevent disease progression and minimize harmful side effects from immunosuppression, as recommended by the KDIGO 2021 guideline 1.
Considerations
The choice of immunosuppressant and the duration of treatment should be individualized based on the patient's response to therapy, the presence of extrarenal disease, and the risk of adverse events secondary to immunosuppressive drugs, as discussed in the KDIGO 2021 guideline 1.
From the Research
Treatment for IgG3 Kappa Glomerulonephritis
The treatment for IgG3 kappa glomerulonephritis, also known as proliferative glomerulonephritis with monoclonal immune deposits (PGNMID), is discussed in the following points:
- According to 2, PGNMID is a newly described entity characterized by monoclonal IgG deposits consisting of single light chain isotype and single heavy chain subtype (IgG1-4) in the kidneys.
- The study 2 presents two cases of patients who were treated with rituximab along with steroids, which led to improvement of proteinuria and renal function.
- The treatment approach for PGNMID involves targeting the clonal proliferation of B-cells, and rituximab has shown promise in this regard 2.
- However, more research is needed to establish the role of rituximab and steroids in the treatment of PGNMID, as the current evidence is based on a limited number of cases 2.
Comparison with Other Glomerulonephritis Treatments
The treatment for IgG3 kappa glomerulonephritis can be compared to other forms of glomerulonephritis:
- For minimal-change glomerulonephritis, proteinuria decreases and disappears during therapy with prednisone, and a comparable effect can be obtained with cyclosporin 3.
- For membranous glomerulonephritis, an alternate month prednisone and chlorambucil regimen may be beneficial, but this approach should be used judiciously to avoid overtreatment 3.
- For IgA-associated glomerulonephritis, there are no well-documented valuable therapies, but calcineurin inhibitors may be promising immunosuppressive agents 4.
- For proliferative glomerulonephritis, mycophenolate mofetil treatment has been associated with histopathological improvement, particularly in patients with endocapillary hypercellularity 5.