, Un patient était antérieurement suivi pour une leucémie aiguë lymphoblastique pro-B, compliquée après deux allogreffes de moelle osseuse d'une GVH (graft-versus-host : réaction du greffon contre l'hôte). Dans certains cas, il existait une discordance entre l'immunoglobuline circulante identifiée et les dépôts présents en immunofluorescence sur la biopsie rénale, SMD) pour un autre patient. L'hémopathie sous-jacente pour 14 patients (74%) était une MGRS (Tableau 6)

, SRA : système rénine angiotensine. TR : transplantation rénale. Vascularite Glom : vascularite glomérulaire. Les sous classes d'IgG ainsi que les chaînes légères ? et ? n'étaient pas disponible sur la biopsie initiale pour certains patients. RESUME Introduction : La glomérulonéphrite proliférative à dépôts monoclonaux d'immunoglobuline (PGNMID) est une entité rare et récemment définie. L'objectif de cette étude est de décrire les caractéristiques cliniques, GNEndoC : glomérulonéphrite endocapillaire. GNExtraC : glomérulonéphrite extracapillaire. GNMP : glomérulonéphrite membrano-proliférative. IF: immunofluorescence. Ig : immunoglobuline. IS : immunosuppresseur. LAL : leucémie aiguë lymphoblastique

. Matériel, Etude descriptive, rétrospective, incluant les patients ayant une PGNMID

, Résultats : Dix-neuf patients ont été inclus, d'âge médian 63 ans. La protéinurie médiane était de 6g/24h et le DFG médian de 26ml/min/1,73m 2 . La forme histologique principale était une glomérulonéphrite membranoproliférative (84%). Les dépôts étaient majoritairement IgG3? (69%)

, Lors du suivi (médiane : 57 mois), 11 patients ont reçu une thérapie immunosuppressive, parmi eux 5 ont obtenu une rémission rénale. Treize patients ont nécessité une prise en charge en hémodialyse et 7 ont été transplantés. Les facteurs de mauvais pronostic rénal étaient le sexe masculin (p=0,02), une protéinurie médiane élevée 8, Une immunoglobuline monoclonale était détectée pour 11 patients, et 5 avaient une hémopathie maligne

, Quatre-vingt-huit pourcents des patients ont récidivé après transplantation. Conclusion : Notre étude confirme le pronostic rénal sombre des patients atteints de PGNMID et l'intérêt du traitement immunosuppresseur. Face à une récidive presque constante sur le greffon, la réalisation d'une biopsie systématique après transplantation semble indiquée. Mots clés : PGNMID, Immunoglobuline G monoclonale, MGRS

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