Abstract
AbstractMonoclonal gammopathy of renal significance (MGRS) represents a group of B-cell or plasma cell proliferative disorders that causes kidney injury via a monoclonal immunoglobulin they produce. The need for this new category of hematologic disorders came from a lack of renal definition in the current diagnostic criteria for plasma cell disorders, Waldenstrom macroglobulinemia and chronic lymphocytic leukemia (CLL). By definition, the hematologic conditions considered to be MGRS do not meet standard consensus criteria for malignancy or treatment, but they cannot be diagnosed as monoclonal gammopathy of undetermined significance (MGUS) because of the end-organ damage. Although generally not life threatening except in the cases of immunoglobulin (AIg) amyloidosis and monoclonal immunoglobulin deposition disease (MIDD) with extrarenal manifestations, the kidney diseases secondary to MGRS are progressive and are associated with significant morbidity. The MGUS designation is also problematic because treatment is not recommended for the MGUS stage of these hematologic disorders. The clone directed therapy required for preservation of kidney function would not be available when these conditions were classified as MGUS, IgM MGUS or low-grade CLL. MGRS clearly separates these conditions from MGUS and allows for the use of clone directed therapy without contradicting current diagnostic criteria and guidelines.
Published Version
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