A study from The Mayo Clinic evaluated long-term outcomes of kidney transplantation in patients with immunoglobulin light chain amyloidosis

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Benign monoclonal gammopathy-associated acute kidney injury: case report and literature review

Background: Benign monoclonal gammopathy (MG) is an MG that is not accompanied by clinical manifestations of plasma cell dyscrasia, such as multiple myeloma, macroglobulinemia, amyloidosis, or other related disorders. Benign MG can progress to malignancy, but seldom causes organ damage. Case report: We presented a case denied any underlying disease who visited our hospital as acute uremia syndrome. Laboratory data indicated renal failure and abnormal paraprotein in the serum and urine. Renal biopsy indicated acute tubular necrosis and cast in the renal tubule. The plasma cell counts were normal in his bone marrow biopsy. The patient had received maintenance hemodialysis for the irreversible renal failure. Conclusion: Benign MG might progress to malignancy or other related disorders in a risk of 1% per year. It also might cause secondary organ impairment, such as kidney.     

Monoclonal gammopathy after intense induction immunosuppression in renal transplant patients

OBJECTIVES.: Incidence and risk factors of post-transplant monoclonal gammopathywere studied in renal transplant patients who received theirgrafts between 1982 and 1992 (n=390 grafts). Immunoelectrophoresiswas performed at annual intervals after transplantation. RESULTS.: Forty-six cases of clonal gammopathy were detected: 35 monoclonal,11 bi- or triclonal, with a predominance of IgG and K light-chainsubtypes (IgG, 39; IgA, 3; IgM, 4; K, 35; , 19). Gammopathywas transient in 17 patients (37%). The 5-year cumulative incidenceof gammopathy was 10.7%, much higher than expected for a groupof similar age from the general population. Thirty of the 46gammopathies appeared within the first 2 years of transplantation.Gammopathy never progressed to multiple myeloma during follow-up(median 1 year; (range 0–10)); one patient subsequentlydeveloped Kaposi sarcoma. The 2-year incidence of gammopathywas much higher in patients transplanted in 1989–1991(23/142) than in 1982–1988 (7/248) (P<0.0001). Thiscoincided with the use of quadruple induction immunosuppression(cyclosporin A+azathioprine+prednisone plus either ATG-Fresenius(ATG-F) or OKT3) since 1989. The risk for acquiring gammopathywithin 2 years of transplantation was 14.7% (95% CI 9.2, 20.3%)in patients receiving quadruple induction therapy, but only3.0% (CI 1.2, 6.1%) without such therapy (P<0.0001). Therisk for patients receiving quadruple immunosuppression withOKT3 was 24.5%, significantly greater than with ATG-F (11.8%,P<0.05). Discriminant analysis revealed that the type ofimmunosuppression, but not age or year of transplantation, wereindependent risk factors for gammopathy. CONCLUSIONS.: Monoclonal gammopathy frequently occurs after renal transplantation.Risks are higher for patients receiving quadruple inductionimmunosuppression, particularly if it includes OKT3. Follow-upof these patients is warranted for the early detection of malignanttransformation.     

Dense deposit disease in association with monoclonal gammopathy of unknown significance

Several renal pathologic entities have been reported in patientswith lymphoplasmacytic disorders with their typical excess immunoglobulinproduction. We report dense deposit disease in a patient whowas discovered to have an IgG kappa monoclonal protein withoutclinical evidence of underlying lymphoplasma cytic malignancyduring investigation for chronic renal failure with associatednephrotic range proteinuria. This case is unusual since densedeposit disease occurs only rarely in older patients and hasnot been reported in association with monoclonal gammopathyof unknown significance. Because of the diversity of renal lesionsassociated with lymphoplasmacytic disorders, renal biopsy isnecessary to assess the type of renal lesion in this patientpopulation.     

C3 glomerulonephritis associated with monoclonal gammopathy: a retrospective case series study from a single institute in China

ObjectiveTo investigate the demographic and clinicopathological features and renal outcomes of Chinese patients with C3 glomerulonephritis in the setting of monoclonal gammopathy.MethodsPatients with renal biopsy-proven C3 glomerulonephritis and detectable serum and/or urine monoclonal immunoglobulin from 2006 to 2018 in Peking University First Hospital were included, their clinical data, renal pathology type, treatment, and prognosis were collected and analyzed.ResultsNineteen patients were enrolled, accounting for 24% of C3GN patients in the study period. The mean age of onset was 55 years old and the gender ratio was 4/15 (female/male). The mean eGFR at biopsy was 49.55 ± 29.81 ml/min/1.73m². The prominent clinical manifestations included nephrotic syndrome (58%), anemia (68%), microscopic hematuria and leukocyturia (58%), and hypocomplementemia (13, 68%). The IgG was the most common isotype of monoclonal Ig on immunofixation electrophoresis. Kidney biopsies revealed a relatively prominent MPGN pattern. Only two patients had direct evidence of monocle immunoglobulins acting as C3GN pathogenic factors. Two patients had concurrent TMA-like renal injuries. The median renal survival was 12 and 15 months, respectively in patients receiving conservative therapy and immunosuppressant therapy, without statistical significance. The efficacy of clone-targeted therapy needed further investigation. Plasma exchange therapy only improved one patient’s renal outcome.ConclusionsThis is the first case series report of C3GN combined with monoclonal Ig in northern China. The renal prognosis of these patients is poor, and immunosuppressant therapies show no advantage over supportive therapy in renal prognosis, while the benefit of clone-targeted chemotherapy is still requiring investigation.     

Thyroid Lymphoma of Mucosa-Associated Lymphoid Tissue with Monoclonal Gammopathy Occurring in an Atomic Bomb Survivor: Report of a Case

(Received for publication on Dec. 14, 1998; accepted on July 13, 1999)     

Multiple myeloma-associated cast nephropathy with crystal structure: case report and review of the literature

The causes of renal failure are diverse. Among them, monoclonal gammopathy is one important but easily-missed cause in aged people. Monoclonal gammopathy may produce a large number of abnormal immunoglobulins and/or fragments and produce different kinds of deposition in tissues, including cast, crystal, fibril and granules. Cast nephropathy is considered the hallmark of the renal disease in patients with multiple myeloma. Crystaglobulinemia syndrome and crystal nephropathy, on the other hand, have been rarely reported. Herein, we report a case of multiple myeloma presented with irreversible renal failure. The biopsy showed massive crystal deposition in bone marrow and kidneys.     

Immunotactoid glomerulopathy is a rare entity with monoclonal and polyclonal variants

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Pathological characteristics of light chain crystalline podocytopathy

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Monoclonal gammopathy after liver transplantation: a risk factor for long-term medical complications other than malignancies

The aims of the study were to evaluate (i) the prevalence of MGUS in patients after liver transplantation (LT), (ii) the role of MGUS as a risk factor for malignancy and other medical complications after LT. One hundred and fifty consecutive patients were included in the study and followed prospectively after LT for more than 18 months. Eighteen patients had MGUS before LT, whereas 49 patients developed MGUS after LT ('de novo' MGUS). Thirty-six of these patients showed a MGUS along all the follow up after LT ('permanent' MGUS). In 31 patients, MGUS disappeared after LT ('transient' MGUS). No patient with MGUS developed B-malignant lymphoproliferative disorder and only one patient developed a myeloma after LT. Comparing patients with 'permanent' MGUS to patients with 'transient' MGUS or without MGUS after LT, the former group showed a higher rate of serious infections (30% versus 13%, P = 0.01), chronic kidney disease (CKD) (75% versus 44%, P = 0.001) and mortality (33% versus 17%, P = 0.04). Permanent MGUS was confirmed as an independent risk factor for serious infections and CKD by multivariate analysis. Permanent MGUS after LT does not entail a significant risk of malignancy, but it is associated with a higher risk of serious infections and CKD.