Abstract
Monoclonal gammopathy of renal significance (MGRS) is a new nosology in modern nephrology and oncohematology. MGRS is defined as kidney injury due to nephrotoxic monoclonal immunoglobulin produced by the B-cell line clone which does not reach the hematological criteria for specific treatment initiation. Monoclonal protein’s pathological effects on kidney parenchyma result in irreversible decline of kidney function till the end stage renal disease that in line with the position of International Consensus of hematologists and nephrologists determinates critical necessity for clone specific treatment in patients with MGRS despite the absence of hematological indications for treatment initiation. Main challenge of MGRS in Russian Federation is an inaccessibility of an in-time diagnostic and appropriate treatment for the great majority of patients due to the following reasons: i) limited knowledge about the MGRS among hematologists and nephrologists; ii) lack of necessary diagnostic resources in most healthcare facilities; iii) lack of approved clinical recommendations and medical economic standards for treatment of this pathological entity. Consensus document comprises the opinion of experts — leading nephrologists and hematologists of Russian Federation — on the problem of MGRS including the incoherence in nosology classification, diagnostics approach and rationale for clone specific treatment. Consensus document is based on conclusions and agreements reached during the conference of leading nephrologists and hematologists of Russia which was held in the framework of symposia «Plasma cell dyscrasias and lymphoproliferative diseases: modern approaches to therapy», 15-16 of March 2019, Pavlov First St-Petersburg State Medical University, St-Petersburg, Russia. The present Consensus is intended to define the principal practical steps to resolve the problem of MGRS in Russian Federation that are summarized as final clauses.
Highlights
MGRS is defined as kidney injury due to nephrotoxic monoclonal immunoglobulin produced by the B-cell line clone which does not reach the hematological criteria for specific treatment initiation
Main challenge of MGRS in Russian Federation is an inaccessibility of an in-time diagnostic and appropriate treatment for the great majority of patients due to the following reasons: i) limited knowledge about the MGRS among hematologists and nephrologists; ii) lack of necessary diagnostic resources in most healthcare facilities; iii) lack of approved clinical recommendations and medical economic standards for treatment of this pathological entity
Consensus document comprises the opinion of experts — leading nephrologists and hematologists of Russian Federation — on the problem of MGRS including the incoherence in nosology classification, diagnostics approach and rationale for clone specific treatment
Summary
1 — Научно-исследовательский институт нефрологии, кафедра пропедевтики внутренних болезней с клиникой, Первый Санкт-Петербургский государственный медицинский университет им. Горбачевой, Первый Санкт-Петербургский государственный медицинский университет им. Санкт-Петербург, Россия 3 — кафедра гематологии, трансфузиологии, трансплантологии факультета постдипломного образования, Первый Санкт-Петербургский государственный медицинский университет им. Санкт-Петербург, Россия 4 — кафедра онкологии, Российская медицинская академия непрерывного профессионального образования, Москва, Россия 5 — кафедра пропедевтики внутренних болезней с клиникой, Первый Санкт-Петербургский государственный медицинский университет им. Санкт-Петербург, Россия 6 — кафедра нефрологии, Московский государственный медико-стоматологический университет им. Москва, Россия 9 — кафедра гематологии и трансфузиологии, Российская медицинская академия непрерывного профессионального образования, Москва, Россия — Дневной стационар гематологии, онкологии и химиотерапии городского гематологического центра, Городская клиническая больница им. Москва, Россия — кафедра внутренних, профессиональных болезней и ревматологии Института клинической медицины, Первый Московский государственный медицинский университет им. Ростов-на-Дону, Россия — Национальный медицинский исследовательский центр гематологии, Москва, Россия — полный список участников консенсуса представлен в конце статьи
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