Original investigation: pathogenesis and treatment of kidney disease and hypertension
Monoclonal gammopathy: significance and possible causality in renal disease

https://doi.org/10.1016/S0272-6386(03)00412-8Get rights and content

Abstract

Background:

Patients with monoclonal gammopathy can develop a variety of related renal lesions or possibly have kidney disease unrelated to their monoclonal gammopathy. We characterized the spectrum of renal diseases associated with monoclonal gammopathy and renal diseases.

Methods:

Patients who underwent renal biopsy and had monoclonal gammopathy on serum and/or urine electrophoresis and/or had a renal biopsy diagnosis related to paraprotein (cryoglobulinemic glomerulonephritis [CG], monoclonal immunoglobulin deposition disease [MIDD], light chain cast nephropathy [CN], or light chain amyloidosis [AL]) were identified.

Results:

One hundred twenty-one patients met the inclusion criteria and were classified as having renal disease related or unrelated to monoclonal gammopathy. Among 66 cases of renal disease related to monoclonal gammopathy, diagnoses were CG (30.3%), MIDD (28.8%), CN (19.7%), AL (19.7%), and CN plus MIDD (1.5%). Among patients with monoclonal gammopathy in serum and/or urine (n = 87), 32 patients (36.8%, included in listing above) had related renal disease. Among 55 patients with monoclonal gammopathy and unrelated renal disease (63.2% of all patients with monoclonal gammopathy), various lesions were found, including diabetic nephropathy (18.1%), focal segmental glomerulosclerosis (18.1%), arterionephrosclerosis (12.7%), membranous glomerulonephritis (9.0%), minimal change disease (7.3%), various immune complex diseases, interstitial nephritis, or nonspecific changes.

Conclusion:

The majority of patients with serum and/or urine monoclonal gammopathy who undergo renal biopsy have disease unrelated to monoclonal gammopathy deposition. This likely reflects the high frequency of monoclonal gammopathy of undetermined significance in older patients and the frequent use of serum and/or urine protein electrophoresis as screening tools in adult patients with 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)

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