Diagnosis of monoclonal gammopathy of renal significance
Monoclonal gammopathy of renal significance (MGRS) regroups all renal disorders caused by a monoclonal immunoglobulin (MIg) secreted by a nonmalignant B-cell clone. By definition, patients with MGRS do not meet the criteria for overt multiple myeloma/B-cell proliferation, and the hematologic disorde...
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| Published in | Kidney international Vol. 87; no. 4; pp. 698 - 711 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Elsevier Inc
01.04.2015
Elsevier Limited |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0085-2538 1523-1755 1523-1755 |
| DOI | 10.1038/ki.2014.408 |
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| Abstract | Monoclonal gammopathy of renal significance (MGRS) regroups all renal disorders caused by a monoclonal immunoglobulin (MIg) secreted by a nonmalignant B-cell clone. By definition, patients with MGRS do not meet the criteria for overt multiple myeloma/B-cell proliferation, and the hematologic disorder is generally consistent with monoclonal gammopathy of undetermined significance (MGUS). However, MGRS is associated with high morbidity due to the severity of renal and sometimes systemic lesions induced by the MIg. Early recognition is crucial, as suppression of MIg secretion by chemotherapy often improves outcomes. The spectrum of renal diseases in MGRS is wide, including old entities such as AL amyloidosis and newly described lesions, particularly proliferative glomerulonephritis with monoclonal Ig deposits and C3 glomerulopathy with monoclonal gammopathy. Kidney biopsy is indicated in most cases to determine the exact lesion associated with MGRS and evaluate its severity. Diagnosis requires integration of morphologic alterations by light microscopy, immunofluorescence (IF), electron microscopy, and in some cases by IF staining for Ig isotypes, immunoelectron microscopy, and proteomic analysis. Complete hematologic workup with serum and urine protein electrophoresis, immunofixation, and serum-free light-chain assay is required. This review addresses the pathologic and clinical features of MGRS lesions, indications of renal biopsy, and a proposed algorithm for the hematologic workup. |
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| AbstractList | Monoclonal gammopathy of renal significance (MGRS) regroups all renal disorders caused by a monoclonal immunoglobulin (MIg) secreted by a nonmalignant B-cell clone. By definition, patients with MGRS do not meet the criteria for overt multiple myeloma/B-cell proliferation, and the hematologic disorder is generally consistent with monoclonal gammopathy of undetermined significance (MGUS). However, MGRS is associated with high morbidity due to the severity of renal and sometimes systemic lesions induced by the MIg. Early recognition is crucial, as suppression of MIg secretion by chemotherapy often improves outcomes. The spectrum of renal diseases in MGRS is wide, including old entities such as AL amyloidosis and newly described lesions, particularly proliferative glomerulonephritis with monoclonal Ig deposits and C3 glomerulopathy with monoclonal gammopathy. Kidney biopsy is indicated in most cases to determine the exact lesion associated with MGRS and evaluate its severity. Diagnosis requires integration of morphologic alterations by light microscopy, immunofluorescence (IF), electron microscopy, and in some cases by IF staining for Ig isotypes, immunoelectron microscopy, and proteomic analysis. Complete hematologic workup with serum and urine protein electrophoresis, immunofixation, and serum-free light-chain assay is required. This review addresses the pathologic and clinical features of MGRS lesions, indications of renal biopsy, and a proposed algorithm for the hematologic workup.Monoclonal gammopathy of renal significance (MGRS) regroups all renal disorders caused by a monoclonal immunoglobulin (MIg) secreted by a nonmalignant B-cell clone. By definition, patients with MGRS do not meet the criteria for overt multiple myeloma/B-cell proliferation, and the hematologic disorder is generally consistent with monoclonal gammopathy of undetermined significance (MGUS). However, MGRS is associated with high morbidity due to the severity of renal and sometimes systemic lesions induced by the MIg. Early recognition is crucial, as suppression of MIg secretion by chemotherapy often improves outcomes. The spectrum of renal diseases in MGRS is wide, including old entities such as AL amyloidosis and newly described lesions, particularly proliferative glomerulonephritis with monoclonal Ig deposits and C3 glomerulopathy with monoclonal gammopathy. Kidney biopsy is indicated in most cases to determine the exact lesion associated with MGRS and evaluate its severity. Diagnosis requires integration of morphologic alterations by light microscopy, immunofluorescence (IF), electron microscopy, and in some cases by IF staining for Ig isotypes, immunoelectron microscopy, and proteomic analysis. Complete hematologic workup with serum and urine protein electrophoresis, immunofixation, and serum-free light-chain assay is required. This review addresses the pathologic and clinical features of MGRS lesions, indications of renal biopsy, and a proposed algorithm for the hematologic workup. Monoclonal gammopathy of renal significance (MGRS) regroups all renal disorders caused by a monoclonal immunoglobulin (MIg) secreted by a nonmalignant B-cell clone. By definition, patients with MGRS do not meet the criteria for overt multiple myeloma/B-cell proliferation, and the hematologic disorder is generally consistent with monoclonal gammopathy of undetermined significance (MGUS). However, MGRS is associated with high morbidity due to the severity of renal and sometimes systemic lesions induced by the MIg. Early recognition is crucial, as suppression of MIg secretion by chemotherapy often improves outcomes. The spectrum of renal diseases in MGRS is wide, including old entities such as AL amyloidosis and newly described lesions, particularly proliferative glomerulonephritis with monoclonal Ig deposits and C3 glomerulopathy with monoclonal gammopathy. Kidney biopsy is indicated in most cases to determine the exact lesion associated with MGRS and evaluate its severity. Diagnosis requires integration of morphologic alterations by light microscopy, immunofluorescence (IF), electron microscopy, and in some cases by IF staining for Ig isotypes, immunoelectron microscopy, and proteomic analysis. Complete hematologic workup with serum and urine protein electrophoresis, immunofixation, and serum-free light-chain assay is required. This review addresses the pathologic and clinical features of MGRS lesions, indications of renal biopsy, and a proposed algorithm for the hematologic workup. |
| Author | Hutchison, Colin A. Sethi, Sanjeev Fervenza, Fernando C. Herrera, Guillermo A. Kyle, Robert A. on behalf of the International Kidney and Monoclonal Gammopathy Research Group Fermand, Jean-Paul Roussel, Murielle Nasr, Samih H. Picken, Maria M. Dispenzieri, Angela Touchard, Guy Bridoux, Frank Leung, Nelson Merlini, Giampaolo Kastritis, Efstathios |
| Author_xml | – sequence: 1 givenname: Frank surname: Bridoux fullname: Bridoux, Frank organization: Department of Nephrology and Transplantation, Centre Hospitalier Universitaire de Poitiers and Centre national de référence maladies rares: amylose AL et autres maladies à depots d’immunoglobulines monoclonales; Université de Poitiers, Poitiers, France – sequence: 2 givenname: Nelson surname: Leung fullname: Leung, Nelson email: leung.nelson@mayo.edu organization: Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA – sequence: 3 givenname: Colin A. surname: Hutchison fullname: Hutchison, Colin A. organization: Department of Medicine, University of Otago, Wellington, New Zealand – sequence: 4 givenname: Guy surname: Touchard fullname: Touchard, Guy organization: Department of Nephrology and Transplantation, Centre Hospitalier Universitaire de Poitiers and Centre national de référence maladies rares: amylose AL et autres maladies à depots d’immunoglobulines monoclonales; Université de Poitiers, Poitiers, France – sequence: 5 givenname: Sanjeev surname: Sethi fullname: Sethi, Sanjeev organization: Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA – sequence: 6 givenname: Jean-Paul surname: Fermand fullname: Fermand, Jean-Paul organization: Department of Hematology and Immunology, Univerisity Hospital St Louis, Paris, France – sequence: 7 givenname: Maria M. surname: Picken fullname: Picken, Maria M. organization: Department of Pathology, Loyola University Medical Center, Maywood, Illinois, USA – sequence: 8 givenname: Guillermo A. surname: Herrera fullname: Herrera, Guillermo A. organization: Department of Pathology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA – sequence: 9 givenname: Efstathios surname: Kastritis fullname: Kastritis, Efstathios organization: Department of Clinical Therapeutics, Alexandra Hospital, University of Athens School of Medicine, Athens, Greece – sequence: 10 givenname: Giampaolo surname: Merlini fullname: Merlini, Giampaolo organization: Department of Molecular Medicine, University of Pavia, Pavia, Italy – sequence: 11 givenname: Murielle surname: Roussel fullname: Roussel, Murielle organization: Hématologie Clinique, Hôpital Purpan, Toulouse, France – sequence: 12 givenname: Fernando C. surname: Fervenza fullname: Fervenza, Fernando C. organization: Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA – sequence: 13 givenname: Angela surname: Dispenzieri fullname: Dispenzieri, Angela organization: Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA – sequence: 14 givenname: Robert A. surname: Kyle fullname: Kyle, Robert A. organization: Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA – sequence: 15 givenname: Samih H. surname: Nasr fullname: Nasr, Samih H. organization: Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA – sequence: 16 surname: on behalf of the International Kidney and Monoclonal Gammopathy Research Group fullname: on behalf of the International Kidney and Monoclonal Gammopathy Research Group |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/25607108$$D View this record in MEDLINE/PubMed |
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| SubjectTerms | Algorithms Biopsy Hematologic Tests Humans Immunoglobulin Light Chains - blood Immunoglobulins - blood Immunoglobulins - urine Kidney - pathology Kidney Diseases - etiology Kidney Diseases - metabolism Kidney Diseases - pathology Monoclonal Gammopathy of Undetermined Significance - complications Monoclonal Gammopathy of Undetermined Significance - diagnosis |
| Title | Diagnosis of monoclonal gammopathy of renal significance |
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