Introduction
Monoclonal gammopathy of renal significance (MGRS) is a recently
described disorder caused by pathologic monoclonal protein (M-protein)
leading to renal disease but little hematologic disease
burden1. Failure to treat patients with MGRS can lead
to poor outcomes due to progression of MGRS to more advanced monoclonal
gammopathies, or end stage renal disease2. We report a
case of MGRS leading to nephrotic syndrome and immunotactoid
glomerulopathy (ITG). We hypothesized that aggressive treatment of the
patient’s MGRS through B-cell depletion and proteasome inhibition would
improve her glomerulopathy and clinical outcomes. She is currently
responding well to treatment with bortezomib, dexamethasone, and
rituximab.