Original investigation: pathogenesis and treatment of kidney disease and hypertensionMonoclonal gammopathy: significance and possible causality in renal disease
Section snippets
Criteria for patient selection and classification
All patients in our renal biopsy files in the Department of Pathology at Vanderbilt University Medical Center (1986 to 1999) and the Horn Laboratory for Renal Biopsy Pathology, Nashville, TN (1996 to 1997) who had either monoclonal spike (M-spike) on serum protein electrophoresis (SPEP) or urine protein electrophoresis (UPEP) and/or who had a renal biopsy diagnosis related to paraprotein deposition were identified. Diseases considered for inclusion in the series were cryoglobulinemic
Population
One hundred twenty-one cases from a total of 4,682 native kidney biopsies (2.6%) met these inclusion criteria. Patients were classified into 2 groups; those with renal disease related to paraprotein deposition, including CG, LCDD, CN, LHCDD, HCDD, and AL, or those with monoclonal protein by serum or urine electrophoresis with renal lesions unrelated to paraprotein deposition. Of note, not all patients in the first group had a serum or urine monoclonal protein detected. Eighty-seven of 121
Discussion
Monoclonal immunoglobulin production may be seen as a consequence of MM, Waldenström's macroglobulinemia, or B-cell lymphoma or represent MGUS.1 The most common monoclonal immunoglobulin-mediated nephropathies include AL-amyloidosis CN, cryoglobulinemia (type I and II), CN, and monoclonal immunoglobulin deposition diseases (MIDDs). MIDDs are characterized by non-Congophilic, nonfibrillar, electron-dense deposits distributed diffusely in the mesangium, glomerular, and/or tubular basement
References (16)
Pathology of dysproteinemiaLight chain amyloidosis, non-amyloid immunoglobulin deposition disease, cryoglobulinemia syndromes, and macroglobulinemia of Waldenström
Hum Pathol
(1988)- et al.
Monoclonal immunoglobulin deposition disease (Randall type). Relationship with structural abnormalities of immunoglobulin chains
Kidney Int
(1994) - et al.
Monoclonal heavy chain (immunoglobulin G3) deposition diseaseReport of a case
Am J Kidney Dis
(1996) - et al.
Heavy chain deposition diseaseThe disease spectrum
Am J Kidney Dis
(1999) Paraneoplastic glomerulopathiesNew insight into an old entity
Kidney Int
(1999)- et al.
Renal lesions in plasma cell dyscrasiasUltrastructural observations
Am J Kidney Dis
(1987) - et al.
Monoclonal gammopathies, mixed cryoglobulinemia, and lymphomas
- et al.
The spectrum of immunoglobulin deposition disease associated with immunocytic dyscrasias
Semin Hematol
(1989)
Cited by (90)
Monoclonal gammopathy of renal significance: Multidisciplinary approach to diagnosis and treatment
2023, Critical Reviews in Oncology/HematologyThe Renal Biopsy in Chronic Kidney Disease
2019, Chronic Renal DiseaseMonoclonal gammopathies of renal significance
2017, NefrologiaCitation Excerpt :Descriptions of different pathological renal processes related to MGs have been increasingly reported. This led to the term MG of renal significance (MGRS)1,23–28 being adopted in order to distinguish and remove the uncertainty that exists on the benign progression of other MGs. The importance of differentiating the term MGRS lies mainly in indicating targeted diagnostic and therapeutic procedures to control the synthesis and secretion of M-proteins — if it is confirmed that these are pathogenically linked to the nephropathy — irrespective of the classic haematological criteria which are more closely linked to the spread of the malignant tumour.3,4,22,26
Dermatologic Manifestations of Chronic Hepatitis C Infection
2017, Clinics in Liver DiseaseCitation Excerpt :Based on the composition of the precipitated immune complex, three different immunochemical types of cryoglobulins have been described. Type 1 cryoglobulins consist of pure monoclonal components and are most often caused by underlying multiple myeloma or Waldenström macroglobulinemia.7 Type 2 is a mixture of monoclonal IgM and polyclonal IgG, and is most often seen in patients with chronic HCV infection, although infection with hepatitis B virus and Epstein-Barr virus were also implicated in some cases.
Monoclonal gammopathy of increasing significance: time to screen?
2023, Haematologica