Abstract
Monoclonal gammopathies are associated with acute and chronic kidney injury. Nephrotoxicity of the secreted monoclonal (M)-protein is related to its biological properties and blood concentration. Little is known about epidemiology, clinical manifestations, and outcome of monoclonal gammopathies in patients with kidney disease. We retrospectively collected data about demographics, clinical manifestations, and renal histological lesions of all patients (n = 1334) who underwent kidney biopsy between January 2000 and March 2017. Monoclonal gammopathy was detected in 174 (13%) patients with a mean age of 66.4 ± 13.1 years. The spectrum of monoclonal gammopathies comprised monoclonal gammopathy of undetermined significate (MGUS) (52.8%), multiple myeloma (MM) (25.2%), primary amyloidosis (AL) (9.1%), smoldering MM (SMM) (4%), non-Hodgkin lymphoma (NHL) (6.8%), and Hodgkin lymphoma (HL) (1.7%). Monoclonal gammopathy of renal significance (MGRS) accounted for 6.5% in patients with MGUS and 14.2% in patients with SMM. Evaluation of kidney biopsy revealed that M-protein was directly involved in causing kidney injury in MM (93.1%). MM was the only gammopathy significantly associated with an increased risk of kidney injury (odds ratio [OR] = 47.5, CI 95%, 13.7–164.9; P ≤ 0.001). While there were no significant differences in the progression toward end-stage renal disease or dialysis (P = 0.776), monoclonal gammopathies were associated with a different risk of death (P = 0.047) at the end of the follow-up. In conclusion, monoclonal gammopathy was a frequent finding (13%) in patients who underwent kidney biopsy. M-protein was secreted by both premalignant (56.8%) and malignant (43.2%) lymphoproliferative clones. Kidney biopsy had a key role in identifying MGRS in patients with MGUS (6.5%) and SMM (14.2%). Among monoclonal gammopathies, only MM was significantly associated with biopsy-proven kidney injury. The rate of end-stage renal disease or dialysis was similar among monoclonal gammopathies, whereas NHL, MM, and SMM showed a higher rate of deaths.
Highlights
Monoclonal gammopathy is a clinical condition characterized by the presence of an abnormal protein—known as monoclonal (M)-protein or paraprotein—in the blood [1]
Considering these limits and the fragmentation of the data published in the literature, we explored the association between monoclonal gammopathies and kidney disease with the aim to define prevalence and clinical manifestations as well as outcomes of these disorders in a cohort of patients who underwent kidney biopsy for renal impairment
We reviewed the charts of 1334 patients who underwent native kidney biopsy for renal dysfunction
Summary
Monoclonal gammopathy is a clinical condition characterized by the presence of an abnormal protein—known as monoclonal (M)-protein or paraprotein—in the blood [1]. Even clones, which have a low propensity to progress toward malignancy and secrete a low amount of M-protein, can be involved in tissue damage, including neuropathy and autoimmune diseases as well as kidney diseases [10] In this setting, tissue deposition of M-protein (direct mechanism) or activation of the complement system without tissue deposition M-protein Deleted(indirect mechanism) may lead to kidney injury [11]. E enthusiasm to understand the causative role of M-protein in patients with renal impairment was tempered by the rarity of the phenomena Considering these limits and the fragmentation of the data published in the literature, we explored the association between monoclonal gammopathies and kidney disease with the aim to define prevalence and clinical manifestations as well as outcomes of these disorders in a cohort of patients who underwent kidney biopsy for renal impairment
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