Summary
Background and objectives
Monoclonal gammopathy of renal significance (MGRS) includes smoldering B cell or plasma cell clones causing renal disease. Our understanding of MGRS is still evolving and through our study we intend to analyze the spectrum of renal involvement in patients with MGRS in our institution in the last 6 years.
Materials and methods
All patients admitted to our hospital with a diagnosis of MGRS from November 2015 to October 2021 were reviewed. It was a retrospective observational study. History, physical examination, and laboratory investigations were meticulously documented.
Results
During the 6 year study period, 108 patients with monoclonal gammopathy of unknown significance (MGUS) were diagnosed, with 29 (26.85%) of them develo** MGRS. Median age of the patients was 55 years with majority being men. On light microscopy, the most common renal biopsy patterns were AL amyloidosis (11 patients), monoclonal immunoglobulin deposition disease (6 patients) followed by proliferative glomerulonephritis with monoclonal IgG deposits in 5 patients.
Conclusions
During the 6 year study period, 108 patients with MGUS were diagnosed, with 29 (26.85%) of them develo** MGRS. Serum immunoelectrophoresis was the most sensitive test for paraprotein detection in our study. IgG kappa and IgG lambda were the most common paraprotein patterns on serum immunofixation. On renal biopsy, AL amyloidosis-lambda was the most common, followed by monoclonal immunoglobulin deposition disease and proliferative glomerulonephritis with monoclonal IgG deposition. Serum creatinine and paraprotein measured by the serum-free light chain (SFLC) ratio had a positive correlation (statistically significant). There was no correlation between urine protein creatinine ratio and M protein measured by serum protein electrophoresis (SPEP) or SFLC ratio in MGRS patients. We conclude by saying that in case of suspicion of MGRS, renal biopsy should be considered.
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Abbreviations
- CSH:
-
crystal storing histiocytosis
- IKMG:
-
International Kidney and Monoclonal Gammopathy
- MGRS:
-
monoclonal gammopathy of renal significance
- SFLC:
-
serum-free light chain assay
- SIEP:
-
serum protein immunofixation
- SPEP:
-
serum protein electrophoresis
- UPCR:
-
urine protein creatinine ratio
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Acknowledgements
This work was presented at Indian Society of Nephrology South Zone Conference held in February 2022 at Kochi, India.
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PT analyzed the data and drafted the manuscript. VS, RA, SB, KB were involved in recruitment of patients and data analysis. MV analyzed the histopathology of all the patients. MK was involved in follow-up, treatment of the patients and contributed to the manuscript. All authors agree with the final manuscript.
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P. Tadkal, S. Vishwanath, V. Mahesha, S. Ballal, R. Augustine, K. Babu and M. Kalashetty declare that they have no competing interests.
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As this was a retrospective observational study, ethical clearance was not applicable. Informed consent: With retrospective collection of data, informed consent was not applicable.
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Tadkal, P., Siddini, V., Mahesha, V. et al. Spectrum of renal involvement in MGRS patients: a 6-year study. memo 16, 129–134 (2023). https://doi.org/10.1007/s12254-023-00873-6
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DOI: https://doi.org/10.1007/s12254-023-00873-6