TY - JOUR
T1 - The evaluation of monoclonal gammopathy of renal significance
T2 - a consensus report of the International Kidney and Monoclonal Gammopathy Research Group
AU - Leung, Nelson
AU - Bridoux, Frank
AU - Batuman, Vecihi
AU - Chaidos, Aristeidis
AU - Cockwell, Paul
AU - D’Agati, Vivette D.
AU - Dispenzieri, Angela
AU - Fervenza, Fernando C.
AU - Fermand, Jean Paul
AU - Gibbs, Simon
AU - Gillmore, Julian D.
AU - Herrera, Guillermo A.
AU - Jaccard, Arnaud
AU - Jevremovic, Dragan
AU - Kastritis, Efstathios
AU - Kukreti, Vishal
AU - Kyle, Robert A.
AU - Lachmann, Helen J.
AU - Larsen, Christopher P.
AU - Ludwig, Heinz
AU - Markowitz, Glen S.
AU - Merlini, Giampaolo
AU - Mollee, Peter
AU - Picken, Maria M.
AU - Rajkumar, Vincent S.
AU - Royal, Virginie
AU - Sanders, Paul W.
AU - Sethi, Sanjeev
AU - Venner, Christopher P.
AU - Voorhees, Peter M.
AU - Wechalekar, Ashutosh D.
AU - Weiss, Brendan M.
AU - Nasr, Samih H.
N1 - Publisher Copyright:
© 2018, Springer Nature Limited.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - The term monoclonal gammopathy of renal significance (MGRS) was introduced by the International Kidney and Monoclonal Gammopathy Research Group (IKMG) in 2012. The IKMG met in April 2017 to refine the definition of MGRS and to update the diagnostic criteria for MGRS-related diseases. Accordingly, in this Expert Consensus Document, the IKMG redefines MGRS as a clonal proliferative disorder that produces a nephrotoxic monoclonal immunoglobulin and does not meet previously defined haematological criteria for treatment of a specific malignancy. The diagnosis of MGRS-related disease is established by kidney biopsy and immunofluorescence studies to identify the monotypic immunoglobulin deposits (although these deposits are minimal in patients with either C3 glomerulopathy or thrombotic microangiopathy). Accordingly, the IKMG recommends a kidney biopsy in patients suspected of having MGRS to maximize the chance of correct diagnosis. Serum and urine protein electrophoresis and immunofixation, as well as analyses of serum free light chains, should also be performed to identify the monoclonal immunoglobulin, which helps to establish the diagnosis of MGRS and might also be useful for assessing responses to treatment. Finally, bone marrow aspiration and biopsy should be conducted to identify the lymphoproliferative clone. Flow cytometry can be helpful in identifying small clones. Additional genetic tests and fluorescent in situ hybridization studies are helpful for clonal identification and for generating treatment recommendations. Treatment of MGRS was not addressed at the 2017 IKMG meeting; consequently, this Expert Consensus Document does not include any recommendations for the treatment of patients with MGRS.
AB - The term monoclonal gammopathy of renal significance (MGRS) was introduced by the International Kidney and Monoclonal Gammopathy Research Group (IKMG) in 2012. The IKMG met in April 2017 to refine the definition of MGRS and to update the diagnostic criteria for MGRS-related diseases. Accordingly, in this Expert Consensus Document, the IKMG redefines MGRS as a clonal proliferative disorder that produces a nephrotoxic monoclonal immunoglobulin and does not meet previously defined haematological criteria for treatment of a specific malignancy. The diagnosis of MGRS-related disease is established by kidney biopsy and immunofluorescence studies to identify the monotypic immunoglobulin deposits (although these deposits are minimal in patients with either C3 glomerulopathy or thrombotic microangiopathy). Accordingly, the IKMG recommends a kidney biopsy in patients suspected of having MGRS to maximize the chance of correct diagnosis. Serum and urine protein electrophoresis and immunofixation, as well as analyses of serum free light chains, should also be performed to identify the monoclonal immunoglobulin, which helps to establish the diagnosis of MGRS and might also be useful for assessing responses to treatment. Finally, bone marrow aspiration and biopsy should be conducted to identify the lymphoproliferative clone. Flow cytometry can be helpful in identifying small clones. Additional genetic tests and fluorescent in situ hybridization studies are helpful for clonal identification and for generating treatment recommendations. Treatment of MGRS was not addressed at the 2017 IKMG meeting; consequently, this Expert Consensus Document does not include any recommendations for the treatment of patients with MGRS.
UR - http://www.scopus.com/inward/record.url?scp=85058013288&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85058013288&partnerID=8YFLogxK
U2 - 10.1038/s41581-018-0077-4
DO - 10.1038/s41581-018-0077-4
M3 - Review article
C2 - 30510265
AN - SCOPUS:85058013288
SN - 1759-5061
VL - 15
SP - 45
EP - 59
JO - Nature Reviews Nephrology
JF - Nature Reviews Nephrology
IS - 1
ER -