Abstract
Monoclonal Gammopathies of Renal Significance (MGRS) are a rather heterogeneous group of renal disorders caused by a circulating monoclonal (MC) immunoglobulin (Ig) component, often in the absence of multiple myeloma (MM) or another clinically relevant lymphoproliferative disorder. Nevertheless, substantial kidney damage could occur, despite the “benign” features of the bone-marrow biopsy. One example is renal amyloidosis, often linked to a small clone of plasma cells, without the invasive features of MM. However, patients with amyloidosis may present with a nephrotic syndrome and renal failure, eventually leading to end-stage kidney disease. At the same time, other organs, such as the heart and the liver, may be severely damaged by Ig light chains or amyloid deposits, occasionally resulting in fatal arrhythmias and/or organ failure. Acute kidney injury (AKI) may as well result from massive excretion of MC proteins, with deposition disease in glomeruli or renal tubules, not rarely obstructed by luminal aggregates, or “casts”. Proliferative glomerulonephritis with monoclonal Ig deposits is another, less frequent clinical presentation of an MGRS. The present review deals with the implications of MGRS for renal function and prognosis, and the potential of tools, such as the renal biopsy, for assessing clinical risk and guiding therapy of the underlying condition.
Highlights
Monoclonal Gammopathies of Undetermined Significance (MGUS) are frequently recognized through the unexpected finding of an electrophoretically distinct monoclonal β or γ globulin peak in serum [1,2]
Ronco and coworkers found that λ light chains (LC) isolated from patients with amyloidosis prompted a “macrophage” phenotypic transformation of cultured human mesangial cells, whereas a “myofibroblastic” phenotype was induced by LC isolated from subjects with deposition disease
One implication of this phenomenon is a greater prevalence of plasma cell dyscrasias among the causes of Acute kidney injury (AKI) in aged patients, so that all events such as rapidly progressive (RP) renal failure in this age group should be thoroughly investigated by nephrologists for a possible Monoclonal Gammopathies of Renal Significance” (MGRS)
Summary
Monoclonal Gammopathies of Undetermined Significance (MGUS) are frequently recognized through the unexpected finding of an electrophoretically distinct monoclonal β or γ globulin peak in serum [1,2] Individuals with such “paraprotein” usually have no evidence of a systemic hematological disease, nor organ damage, such as heart failure, liver dysfunction, bone/skeletal alterations, or renal dysfunction. Certain forms of MGUS damage to the kidney could be massive, despite marginal clonal abnormalities of plasma cells at the without features of overt MM, previously known as “smoldering myeloma”, fall into this newer bone marrow biopsy [6,7,8]. For assessing clinical risk and guiding the hematologist to the therapy of the underlying condition
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
