Diagnosis of monoclonal gammopathy of renal significance

Frank Bridoux, Nelson Leung, Colin A. Hutchison, Guy Touchard, Sanjeev M Sethi, Jean Paul Fermand, Maria M. Picken, Guillermo A. Herrera, Efstathios Kastritis, Giampaolo Merlini, Murielle Roussel, Fernando Custodio Fervenza, Angela Dispenzieri, Robert A. Kyle, Samih H. Nasr

Research output: Contribution to journalArticle

171 Citations (Scopus)

Abstract

Monoclonal gammopathy of renal significance (MGRS) regroups all renal disorders caused by a monoclonal immunoglobulin (MIg) secreted by a nonmalignant B-cell clone. By definition, patients with MGRS do not meet the criteria for overt multiple myeloma/B-cell proliferation, and the hematologic disorder is generally consistent with monoclonal gammopathy of undetermined significance (MGUS). However, MGRS is associated with high morbidity due to the severity of renal and sometimes systemic lesions induced by the MIg. Early recognition is crucial, as suppression of MIg secretion by chemotherapy often improves outcomes. The spectrum of renal diseases in MGRS is wide, including old entities such as AL amyloidosis and newly described lesions, particularly proliferative glomerulonephritis with monoclonal Ig deposits and C3 glomerulopathy with monoclonal gammopathy. Kidney biopsy is indicated in most cases to determine the exact lesion associated with MGRS and evaluate its severity. Diagnosis requires integration of morphologic alterations by light microscopy, immunofluorescence (IF), electron microscopy, and in some cases by IF staining for Ig isotypes, immunoelectron microscopy, and proteomic analysis. Complete hematologic workup with serum and urine protein electrophoresis, immunofixation, and serum-free light-chain assay is required. This review addresses the pathologic and clinical features of MGRS lesions, indications of renal biopsy, and a proposed algorithm for the hematologic workup.Kidney International advance online publication, 21 January 2015; doi:10.1038/ki.2014.408.

Original languageEnglish (US)
JournalKidney International
DOIs
StateAccepted/In press - Jan 21 2015

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Paraproteinemias
Kidney
Immunoglobulins
B-Lymphocytes
Monoclonal Gammopathy of Undetermined Significance
Biopsy
Light
Immunoelectron Microscopy
Amyloidosis
Glomerulonephritis
Multiple Myeloma
Fluorescence Microscopy
Proteomics
Fluorescent Antibody Technique
Electrophoresis
Publications
Blood Proteins
Electron Microscopy
Clone Cells
Cell Proliferation

ASJC Scopus subject areas

  • Nephrology

Cite this

Bridoux, F., Leung, N., Hutchison, C. A., Touchard, G., Sethi, S. M., Fermand, J. P., ... Nasr, S. H. (Accepted/In press). Diagnosis of monoclonal gammopathy of renal significance. Kidney International. https://doi.org/10.1038/ki.2014.408

Diagnosis of monoclonal gammopathy of renal significance. / Bridoux, Frank; Leung, Nelson; Hutchison, Colin A.; Touchard, Guy; Sethi, Sanjeev M; Fermand, Jean Paul; Picken, Maria M.; Herrera, Guillermo A.; Kastritis, Efstathios; Merlini, Giampaolo; Roussel, Murielle; Fervenza, Fernando Custodio; Dispenzieri, Angela; Kyle, Robert A.; Nasr, Samih H.

In: Kidney International, 21.01.2015.

Research output: Contribution to journalArticle

Bridoux, F, Leung, N, Hutchison, CA, Touchard, G, Sethi, SM, Fermand, JP, Picken, MM, Herrera, GA, Kastritis, E, Merlini, G, Roussel, M, Fervenza, FC, Dispenzieri, A, Kyle, RA & Nasr, SH 2015, 'Diagnosis of monoclonal gammopathy of renal significance', Kidney International. https://doi.org/10.1038/ki.2014.408
Bridoux F, Leung N, Hutchison CA, Touchard G, Sethi SM, Fermand JP et al. Diagnosis of monoclonal gammopathy of renal significance. Kidney International. 2015 Jan 21. https://doi.org/10.1038/ki.2014.408
Bridoux, Frank ; Leung, Nelson ; Hutchison, Colin A. ; Touchard, Guy ; Sethi, Sanjeev M ; Fermand, Jean Paul ; Picken, Maria M. ; Herrera, Guillermo A. ; Kastritis, Efstathios ; Merlini, Giampaolo ; Roussel, Murielle ; Fervenza, Fernando Custodio ; Dispenzieri, Angela ; Kyle, Robert A. ; Nasr, Samih H. / Diagnosis of monoclonal gammopathy of renal significance. In: Kidney International. 2015.
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