Renal disease associated with monoclonal gammopathy

Increasingly, monoclonal gammopathy is recognized as a cause of kidney disease regardless of the hematologic malignancy. As a result, the term monoclonal gammopathy of renal significance (MGRS) has been introduced to distinguish these patients from those with the benign monoclonal gammopathy of undetermined significance. Kidney diseases of MGRS can be classified according to the type of deposits in the kidney. The three major categories are organized (which including fibrillar, microtubular, and crystalline), non-organized, and none. Another characteristic of MGRS-associated nephropathies is their high rate of recurrence after kidney transplant. It is therefore important that kidney transplant recipient be properly treated prior to kidney transplantation. This requires confirmation that a MGRS is responsible for the disease, which can only be done by a kidney biopsy. The treatment should optimally target the clone producing the MGRS rather than be based on renal histology.