Monoclonal gammopathy of renal significance – diagnostic and therapeutic problems Review article

Main Article Content

Grzegorz Kade
Sebastian Spaleniak
Janusz Hałka
Stefan Antosiewicz

Abstract

The term monoclonal gammopathy of renal significance MGRS means a group of renal diseases resulting from the presence of the monoclonal protein produced by plasmatic cells or other clones of B cells. The patients with MGRS do not fulfill the diagnostics criteria both of multiple myeloma and other neoplasm originating from B cells. The involvement of different renal structures in the course of MGRS results the dysfunction of kidneys. The monoclonal protein may injure the glomerular structures (including vascular) as well as tubular structures (interstitial in more wide sense). The early diagnosis of MGRS is difficult and the late detection of the disease is connected with high risk of irreversible renal damage. Therefore, the multidisciplinary cooperation – including general practitioners, nephrologists, hematologists and nephro-pathologists – is particularly important for the diagnostics and treatment of MGRS cases. This new hemato-nephrological meta-disease entity is connected with relatively high morbidity and mortality as well as relapses in transplanted kidney. The decision of the treatment initiation against the toxic clone in MGRS cases results mainly from the nephrological reasons. The article presents current diagnostic and therapeutic possibilities that may be used in MGRS patients. The main purpose of this article was to present the current state of knowledge regarding the diagnostics and treatment of MGRS.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Article Details

How to Cite
1.
Kade G, Spaleniak S, Hałka J, Antosiewicz S. Monoclonal gammopathy of renal significance – diagnostic and therapeutic problems. OncoReview [Internet]. 2021Feb.4 [cited 2024Nov.22];10(4(40):139-44. Available from: https://journalsmededu.pl/index.php/OncoReview/article/view/1145
Section
HEMATO-ONCOLOGY

References

1. Leung N, Bridoux F, Hutchison CA et al. Monoclonal gammopathy of renal significance: when MGUS is no longer undetermined or insignificant. Blood. 2012; 120(22): 4292-5. http://doi.org/10.1182/blood-2012-07-445304.
2. Menè P, De Alexandris L, Moioli A et al. Monoclonal Gammopathies of Renal Significance: Renal Biopsy and Beyond. Cancers (Basel). 2020; 12(7): 1741. http://doi.org/10.3390/cancers12071741.
3. Leung N, Bridoux F, Batuman V et al. The evaluation of monoclonal gammopathy of renal significance: a consensus report of the International Kidney and Monoclonal Gammopathy Research Group. Nat Rev Nephrol. 2019; 15(1): 45-59. http://doi.org/10.1038/s41581-018-0077-4. Erratum in: Nat Rev Nephrol. 2019; 15(2): 121.
4. Steiner N, Göbel G, Suchecki P et al. Monoclonal gammopathy of renal significance (MGRS) increases the risk for progression to multiple myeloma: an observational study of 2935 MGUS patients. Oncotarget. 2017; 9(2): 2344-56. http://doi.org/10.18632/oncotarget.23412.
5. Giannopoulos K, Jamroziak K, Usnarska-Zubkiewicz L et al. Zalecenia Polskiej Grupy Szpiczakowej dotyczące rozpoznawania i leczenia szpiczaka plazmocytowego oraz innych dyskrazji plazmocytowych na rok 2018/2019. Acta Acta Haematologica Polonica. 2018; 49(4): 157-206.
6. Jain A, Haynes R, Kothari J et al. Pathophysiology and management of monoclonal gammopathy of renal significance. Blood Adv. 2019; 3(15): 2409-23. http://doi.org/10.1182/bloodadvances.2019031914.
7. Fish R, Pinney J, Jain P et al. The incidence of major hemorrhagic complications after renal biopsies in patients with monoclonal gammopathies. Clin J Am Soc Nephrol. 2010; 5(11): 1977-80. http://doi.org/10.2215/CJN.00650110.
8. Bridoux F, Leung N, Hutchison CA et al. Diagnosis of monoclonal gammopathy of renal significance. Kidney Int. 2015; 87(4): 698-711. http://doi.org/10.1038/ki.2014.408.
9. Ciocchini M, Arbelbide J, Musso CG. Monoclonal gammopathy of renal significance (MGRS): the characteristics and significance of a new meta-entity. Int Urol Nephrol. 2017;49(12):2171-2175. http://doi.org/10.1007/s11255-017-1594-y .
10. Usnarska-Zubkiewicz L, Dębski J, Kuliczkowski K. Jak obecnie leczyć chorego na szpiczaka mnogiego z niewydolnością nerek? Acta Haematologica Polonica. 2011; 42(2): 215-25.
11. Spodzieja M, Rodziewicz-Motowidło S, Szymanska A. Hyphenated Mass Spectrometry Techniques in the Diagnosis of Amyloidosis. Curr Med Chem. 2019; 26(1): 104-20. http://doi.org/10.2174/0929867324666171003113019.
12. Sethi S, Theis JD, Leung N et al. Mass spectrometry-based proteomic diagnosis of renal immunoglobulin heavy chain amyloidosis. Clin J Am Soc Nephrol. 2010; 5(12): 2180-7. http://doi.org/10.2215/CJN.02890310.
13. Skwierawska K, Waszczuk-Gajda A, Perkowska-Ptasińska A et al. Gammapatie monoklonalne o znaczeniu nerkowym. Acta Haematologica Polonica. 2018; 49(2): 50-8.
14. Jain A, Haynes R, Kothari J et al. Pathophysiology and management of monoclonal gammopathy of renal significance. Blood Adv. 2019; 3(15): 2409-23. http://doi.org/10.1182/bloodadvances.2019031914.
15. Fermand JP, Bridoux F, Kyle RA et al. International Kidney and Monoclonal Gammopathy Research Group. How I treat monoclonal gammopathy of renal significance (MGRS). Blood. 2013; 122(22): 3583-90. http://doi.org/10.1182/blood-2013-05-495929.
16. Amaador K, Peeters H, Minnema MC et al. Monoclonal gammopathy of renal significance (MGRS) histopathologic classification, diagnostic workup, and therapeutic options. Neth J Med. 2019; 77(7): 243-54.
17. Gandolfi S, Laubach JP, Hideshima T et al. The proteasome and proteasome inhibitors in multiple myeloma. Cancer Metastasis Rev. 2017; 36(4): 561-84. http://doi.org/10.1007/s10555-017-9707-8.
18. Huang J, Sun C, Su H et al. Bortezomib-Based Chemotherapy with Autologous Stem Cell Transplantation for Monoclonal Gammopathy of Renal Significance: A Case Report and Literature Review. Kidney Blood Press Res. 2019; 44(4): 858-69. http://doi.org/10.1159/000501314.
19. Khera A, Panitsas F, Djebbari F et al. Long term outcomes in monoclonal gammopathy of renal significance. Br J Haematol. 2019; 186(5): 706-16. http://doi.org/10.1111/bjh.15987.
20. Leung N, Drosou ME, Nasr SH. Dysproteinemias and Glomerular Disease. Clin J Am Soc Nephrol. 2018; 13(1): 128-39. http://doi.org/10.2215/ CJN.00560117.
21. Dima D, Dower J, Comenzo RL et al. Evaluating Daratumumab in the Treatment of Multiple Myeloma: Safety, Efficacy and Place in Therapy. Cancer Manag Res. 2020; 12: 7891-903. http://doi.org/10.2147/CMAR.S212526.
22. Kastritis E, Theodorakakou F, Roussou M et al. Daratumumab-based therapy for patients with monoclonal gammopathy of renal significance. Br J Haematol. 2020. http://doi.org/10.1111/bjh.17052.
23. Leung N, Dingli D. Venetoclax in a Patient With Light Chain Deposition Disease Secondary to MGRS That Progressed After Kidney Transplantation. Clin Lymphoma Myeloma Leuk. 2020; 20(8): e488-e491. http://doi.org/10.1016/j.clml.2020.03.013.
24. Cibeira MT, Sanchorawala V, Seldin DC et al. Outcome of AL amyloidosis after high-dose melphalan and autologous stem cell transplantation: long-term results in a series of 421 patients. Blood. 2011; 118(16): 4346-52. http://doi.org/10.1182/blood-2011-01-330738.
25. Palladini G, Kastritis E, Maurer MS et al. Daratumumab plus CyBorD for patients with newly diagnosed AL amyloidosis: safety run-in results of ANDROMEDA. Blood. 2020; 136(1): 71-80. http://doi.org/10.1182/blood.2019004460.
26. Nasr SH, Valeri AM, Cornell LD et al. Fibrillary glomerulonephritis: a report of 66 cases from a single institution. Clin J Am Soc Nephrol. 2011; 6(4): 775-84. http://doi.org/10.2215/CJN.08300910.
27. Bridoux F, Hugue V, Coldefy O et al. Fibrillary glomerulonephritis and immunotactoid (microtubular) glomerulopathy are associated with distinct immunologic features. Kidney Int. 2002; 62(5): 1764-75. http://doi.org/10.1046/j.1523-1755.2002.00628.x.
28. Nasr SH, Satoskar A, Markowitz GS et al. Proliferative glomerulonephritis with monoclonal IgG deposits. J Am Soc Nephrol. 2009; 20(9): 2055-64. http://doi.org/10.1681/ASN.2009010110.
30. Gumber R, Cohen JB, Palmer MB et al. A clone-directed approach may improve diagnosis and treatment of proliferative glomerulonephritis with monoclonal immunoglobulin deposits. Kidney Int. 2018; 94(1): 199-205.
31. Chauvet S, Frémeaux-Bacchi V, Petitprez F et al. Treatment of B-cell disorder improves renal outcome of patients with monoclonal gammopathy-associated C3 glomerulopathy. Blood. 2017; 129(11): 1437-47. http://doi.org/10.1182/blood-2016-08-737163.
32. Zand L, Kattah A, Fervenza FC et al. C3 glomerulonephritis associated with monoclonal gammopathy: a case series. Am J Kidney Dis. 2013; 62(3): 506-14. http://doi.org/10.1053/j.ajkd.2013.02.370.
33. Moog P, Jost PJ, Büttner-Herold M. Eculizumab as salvage therapy for recurrent monoclonal gammopathy-induced C3 glomerulopathy in a kidney allograft. BMC Nephrol. 2018; 19(1): 106. http://doi.org/10.1186/s12882-018-0904-7.

Most read articles by the same author(s)