Urinary albumin excretion patterns of patients with cast nephropathy and other monoclonal gammopathy-related kidney diseases.

Nelson Leung, Morie Gertz, Robert A. Kyle, Fernando Custodio Fervenza, Maria Irazabal Mira, Alfonso Eirin, Shaji K Kumar, Stephen S. Cha, S Vincent Rajkumar, Martha Lacy, Steve R. Zeldenrust, Francis K. Buadi, Suzanne R. Hayman, Samih H. Nasr, Sanjeev M Sethi, Marina Ramirez-Alvarado, Thomas Elmer Witzig, Sandra Herrmann, Angela Dispenzieri

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Abstract

Multiple myeloma is responsible for a wide variety of renal pathologies. Urinary protein and monoclonal spike cannot be used to diagnose cast nephropathy (CN). Because albuminuria is a hallmark of glomerular disease, this study evaluated the percentage of urinary albumin excretion (%UAE) as a tool to differentiate CN from Ig light chain amyloidosis (AL), light chain deposition disease (LCDD), and acute tubular necrosis (ATN). Patients were selected from the Renal Biopsy Database and the Dysproteinemia Database. Participants were excluded if laboratory data were missing within 1 week of the renal biopsy. The %UAE was obtained from urine protein electrophoresis. From 1992 to 2011, 260 patients were biopsied (177 with AL, 28 with LCDD, 43 with CN, and 12 with ATN). The %UAE for CN patients was significantly lower (7%) than for ATN (25%), LCDD (55%), and AL (70%) patients (P<0.001). Significant differences were also found in serum creatinine, serum albumin, free light chain ratio, total urine protein, and urine monoclonal spike; only the %UAE remained independently associated with CN in a logistic regression model (P<0.001). The area under the curve for the receiver operator characteristic curve for %UAE was 0.99. At <25%, the %UAE had a sensitivity of 0.98, specificity of 0.94, positive predictive value of 0.75, and negative predictive value of 0.99. This study showed that %UAE was significantly less in CN than the other three renal lesions and %UAE may thus be helpful in diagnosis of CN.

Original languageEnglish (US)
Pages (from-to)1964-1968
Number of pages5
JournalClinical journal of the American Society of Nephrology : CJASN
Volume7
Issue number12
StatePublished - Dec 2012

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Paraproteinemias
Kidney Diseases
Albumins
Light
Amyloidosis
Kidney
Necrosis
Urine
Logistic Models
Databases
Biopsy
Proteins
Albuminuria
Acute Disease
Multiple Myeloma
Serum Albumin
Area Under Curve
Electrophoresis
Creatinine
Pathology

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{a8ae7368f7af443aa8c0ec39da6c5366,
title = "Urinary albumin excretion patterns of patients with cast nephropathy and other monoclonal gammopathy-related kidney diseases.",
abstract = "Multiple myeloma is responsible for a wide variety of renal pathologies. Urinary protein and monoclonal spike cannot be used to diagnose cast nephropathy (CN). Because albuminuria is a hallmark of glomerular disease, this study evaluated the percentage of urinary albumin excretion ({\%}UAE) as a tool to differentiate CN from Ig light chain amyloidosis (AL), light chain deposition disease (LCDD), and acute tubular necrosis (ATN). Patients were selected from the Renal Biopsy Database and the Dysproteinemia Database. Participants were excluded if laboratory data were missing within 1 week of the renal biopsy. The {\%}UAE was obtained from urine protein electrophoresis. From 1992 to 2011, 260 patients were biopsied (177 with AL, 28 with LCDD, 43 with CN, and 12 with ATN). The {\%}UAE for CN patients was significantly lower (7{\%}) than for ATN (25{\%}), LCDD (55{\%}), and AL (70{\%}) patients (P<0.001). Significant differences were also found in serum creatinine, serum albumin, free light chain ratio, total urine protein, and urine monoclonal spike; only the {\%}UAE remained independently associated with CN in a logistic regression model (P<0.001). The area under the curve for the receiver operator characteristic curve for {\%}UAE was 0.99. At <25{\%}, the {\%}UAE had a sensitivity of 0.98, specificity of 0.94, positive predictive value of 0.75, and negative predictive value of 0.99. This study showed that {\%}UAE was significantly less in CN than the other three renal lesions and {\%}UAE may thus be helpful in diagnosis of CN.",
author = "Nelson Leung and Morie Gertz and Kyle, {Robert A.} and Fervenza, {Fernando Custodio} and {Irazabal Mira}, Maria and Alfonso Eirin and Kumar, {Shaji K} and Cha, {Stephen S.} and Rajkumar, {S Vincent} and Martha Lacy and Zeldenrust, {Steve R.} and Buadi, {Francis K.} and Hayman, {Suzanne R.} and Nasr, {Samih H.} and Sethi, {Sanjeev M} and Marina Ramirez-Alvarado and Witzig, {Thomas Elmer} and Sandra Herrmann and Angela Dispenzieri",
year = "2012",
month = "12",
language = "English (US)",
volume = "7",
pages = "1964--1968",
journal = "Clinical Journal of the American Society of Nephrology",
issn = "1555-9041",
publisher = "American Society of Nephrology",
number = "12",

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TY - JOUR

T1 - Urinary albumin excretion patterns of patients with cast nephropathy and other monoclonal gammopathy-related kidney diseases.

AU - Leung, Nelson

AU - Gertz, Morie

AU - Kyle, Robert A.

AU - Fervenza, Fernando Custodio

AU - Irazabal Mira, Maria

AU - Eirin, Alfonso

AU - Kumar, Shaji K

AU - Cha, Stephen S.

AU - Rajkumar, S Vincent

AU - Lacy, Martha

AU - Zeldenrust, Steve R.

AU - Buadi, Francis K.

AU - Hayman, Suzanne R.

AU - Nasr, Samih H.

AU - Sethi, Sanjeev M

AU - Ramirez-Alvarado, Marina

AU - Witzig, Thomas Elmer

AU - Herrmann, Sandra

AU - Dispenzieri, Angela

PY - 2012/12

Y1 - 2012/12

N2 - Multiple myeloma is responsible for a wide variety of renal pathologies. Urinary protein and monoclonal spike cannot be used to diagnose cast nephropathy (CN). Because albuminuria is a hallmark of glomerular disease, this study evaluated the percentage of urinary albumin excretion (%UAE) as a tool to differentiate CN from Ig light chain amyloidosis (AL), light chain deposition disease (LCDD), and acute tubular necrosis (ATN). Patients were selected from the Renal Biopsy Database and the Dysproteinemia Database. Participants were excluded if laboratory data were missing within 1 week of the renal biopsy. The %UAE was obtained from urine protein electrophoresis. From 1992 to 2011, 260 patients were biopsied (177 with AL, 28 with LCDD, 43 with CN, and 12 with ATN). The %UAE for CN patients was significantly lower (7%) than for ATN (25%), LCDD (55%), and AL (70%) patients (P<0.001). Significant differences were also found in serum creatinine, serum albumin, free light chain ratio, total urine protein, and urine monoclonal spike; only the %UAE remained independently associated with CN in a logistic regression model (P<0.001). The area under the curve for the receiver operator characteristic curve for %UAE was 0.99. At <25%, the %UAE had a sensitivity of 0.98, specificity of 0.94, positive predictive value of 0.75, and negative predictive value of 0.99. This study showed that %UAE was significantly less in CN than the other three renal lesions and %UAE may thus be helpful in diagnosis of CN.

AB - Multiple myeloma is responsible for a wide variety of renal pathologies. Urinary protein and monoclonal spike cannot be used to diagnose cast nephropathy (CN). Because albuminuria is a hallmark of glomerular disease, this study evaluated the percentage of urinary albumin excretion (%UAE) as a tool to differentiate CN from Ig light chain amyloidosis (AL), light chain deposition disease (LCDD), and acute tubular necrosis (ATN). Patients were selected from the Renal Biopsy Database and the Dysproteinemia Database. Participants were excluded if laboratory data were missing within 1 week of the renal biopsy. The %UAE was obtained from urine protein electrophoresis. From 1992 to 2011, 260 patients were biopsied (177 with AL, 28 with LCDD, 43 with CN, and 12 with ATN). The %UAE for CN patients was significantly lower (7%) than for ATN (25%), LCDD (55%), and AL (70%) patients (P<0.001). Significant differences were also found in serum creatinine, serum albumin, free light chain ratio, total urine protein, and urine monoclonal spike; only the %UAE remained independently associated with CN in a logistic regression model (P<0.001). The area under the curve for the receiver operator characteristic curve for %UAE was 0.99. At <25%, the %UAE had a sensitivity of 0.98, specificity of 0.94, positive predictive value of 0.75, and negative predictive value of 0.99. This study showed that %UAE was significantly less in CN than the other three renal lesions and %UAE may thus be helpful in diagnosis of CN.

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JO - Clinical Journal of the American Society of Nephrology

JF - Clinical Journal of the American Society of Nephrology

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