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Abstract
Objectives: To analyze the clinical characteristics and renal pathological manifestations of patients with monoclonal gammopathy (MG) and kidney injury.Methods: This was a multicenter retrospective cohort study conducted at four tertiary hospitals in China. The study population comprised patients with MG admitted from January 1 2013 to December 31 2020. Hospitalization records, laboratory data, and kidney biopsy reports of all patients were collected from the electronic hospital information systems. The study outcomes included kidney disease progression and major hemorrhagic complications after kidney biopsy.Results: We identified 1,164 patients with MG, 782 (67.2%) of whom had underlying kidney injury. Of 101 patients who underwent kidney biopsy, 16 had malignant neoplasms. Amyloid nephropathy was the most common finding (n = 34, 33.7%), followed by membranous nephropathy (n = 18, 17.8%) and membranoproliferative nephritis (n = 8, 7.9%). Among 85 patients with non-malignant hematologic conditions who underwent kidney biopsy, 43 had MG of renal significance (MGRS) related lesions and 42 had MG-unrelated lesions. The risk of kidney disease progression was higher in patients with kidney injury than in patients without kidney injury.Conclusion: Among patients with MG and kidney injury, only 12.9% underwent kidney biopsy and more than 40% of these patients had MG-unrelated lesions. A kidney biopsy is safe and essential to maximize the possibility of correct diagnosis for patients with clinically suspected MG of renal significance (MGRS).
Highlights
Monoclonal gammopathy (MG) is defined as the presence of a monoclonal immunoglobulin (MIg) in serum resulting from the clonal proliferation of Ig-producing plasma cells or B-lymphocytes [1, 2]
Monoclonal gammopathies are a group of disorders ranging from non-malignant small clonal proliferations to malignant neoplasms of plasma cells or B-lymphocytes [3, 4]
This term was introduced by the International Kidney and Monoclonal Gammopathy Research Group (IKMG) in 2012 and updated to include all Bcell and plasma cell proliferative disorders that produce a nephrotoxic MIg by the new IKMG consensus in 2019 [9]
Summary
Monoclonal gammopathy (MG) is defined as the presence of a monoclonal immunoglobulin (MIg) in serum resulting from the clonal proliferation of Ig-producing plasma cells or B-lymphocytes [1, 2]. Kidney damage secondary to MIg in the absence of hematologic malignancy has been increasingly recognized and is called MG of renal significance (MGRS) [8]. This term was introduced by the International Kidney and Monoclonal Gammopathy Research Group (IKMG) in 2012 and updated to include all Bcell and plasma cell proliferative disorders that produce a nephrotoxic MIg by the new IKMG consensus in 2019 [9]. Once the hematologic condition progresses to overt multiple myeloma (MM), Waldenström macroglobulinemia (WM), advanced-stage chronic lymphocytic leukemia, or malignant lymphoma (as defined by their respective established disease criteria), these diseases are no longer considered MGRS and affected patients are managed according to disease-specific protocols
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