Nattawat Klomjit1, Nelson Leung1,2, Fernando Fervenza1, Sanjeev Sethi3, Ladan Zand4. 1. Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota. 2. Division of Hematology, Mayo Clinic, Rochester, Minnesota. 3. Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota. 4. Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota zand0032@umn.edu.
Abstract
BACKGROUND: Little is known about the rate and predictors of finding lesions of monoclonal gammopathy (MG) of renal significance (MGRS) on kidney biopsy specimens among patients with MG. METHODS: We reviewed the medical records from 2013 to 2018 at the Mayo Clinic in Rochester, Minnesota, to identify patients with MG and whether they had undergone a kidney biopsy. In a more select group of patients with MG from 2017 to 2018, we conducted a review of records to determine how many had underlying CKD, which of those with CKD had undergone a kidney biopsy, and reasons for deferring a kidney biopsy. RESULTS: Between 2013 and 2018, we identified 6300 patients who had MG, 160 (2.5%) of whom had undergone a kidney biopsy. Of the 160 patients, 64 (40%) had an MGRS lesion; amyloid light chain amyloidosis, the most common finding, accounted for nearly half of these lesions. In the non-MGRS group comprising 96 patients, 23 had arteriosclerosis, the most common finding. In multivariate analysis, strong predictors of finding an MGRS lesion included the presence of an elevated free light chain ratio, proteinuria, and hematuria. Among 596 patients with CKD and MG from 2017 to 2018, 62 (10.4%) underwent a kidney biopsy. Kidney biopsy was deferred for 70 patients (20%); for 62 of the 70, the diagnosis was already known, and eight were not candidates for therapy. Younger age and higher proteinuria and serum creatinine levels increased the likelihood that the patient would undergo a kidney biopsy. CONCLUSIONS: Proteinuria ≥1.5 g/d, hematuria, and an elevated free light chain ratio increase the likelihood of finding MGRS, and a kidney biopsy should be highly considered in such patients.
BACKGROUND: Little is known about the rate and predictors of finding lesions of monoclonal gammopathy (MG) of renal significance (MGRS) on kidney biopsy specimens among patients with MG. METHODS: We reviewed the medical records from 2013 to 2018 at the Mayo Clinic in Rochester, Minnesota, to identify patients with MG and whether they had undergone a kidney biopsy. In a more select group of patients with MG from 2017 to 2018, we conducted a review of records to determine how many had underlying CKD, which of those with CKD had undergone a kidney biopsy, and reasons for deferring a kidney biopsy. RESULTS: Between 2013 and 2018, we identified 6300 patients who had MG, 160 (2.5%) of whom had undergone a kidney biopsy. Of the 160 patients, 64 (40%) had an MGRS lesion; amyloid light chain amyloidosis, the most common finding, accounted for nearly half of these lesions. In the non-MGRS group comprising 96 patients, 23 had arteriosclerosis, the most common finding. In multivariate analysis, strong predictors of finding an MGRS lesion included the presence of an elevated free light chain ratio, proteinuria, and hematuria. Among 596 patients with CKD and MG from 2017 to 2018, 62 (10.4%) underwent a kidney biopsy. Kidney biopsy was deferred for 70 patients (20%); for 62 of the 70, the diagnosis was already known, and eight were not candidates for therapy. Younger age and higher proteinuria and serum creatinine levels increased the likelihood that the patient would undergo a kidney biopsy. CONCLUSIONS:Proteinuria ≥1.5 g/d, hematuria, and an elevated free light chain ratio increase the likelihood of finding MGRS, and a kidney biopsy should be highly considered in such patients.
Authors: Robert A Kyle; Terry M Therneau; S Vincent Rajkumar; Dirk R Larson; Matthew F Plevak; Janice R Offord; Angela Dispenzieri; Jerry A Katzmann; L Joseph Melton Journal: N Engl J Med Date: 2006-03-30 Impact factor: 91.245
Authors: Colin A Hutchison; Stephen Harding; Pete Hewins; Graham P Mead; John Townsend; Arthur R Bradwell; Paul Cockwell Journal: Clin J Am Soc Nephrol Date: 2008-11 Impact factor: 8.237
Authors: Nelson Leung; Frank Bridoux; Vecihi Batuman; Aristeidis Chaidos; Paul Cockwell; Vivette D D'Agati; Angela Dispenzieri; Fernando C Fervenza; Jean-Paul Fermand; Simon Gibbs; Julian D Gillmore; Guillermo A Herrera; Arnaud Jaccard; Dragan Jevremovic; Efstathios Kastritis; Vishal Kukreti; Robert A Kyle; Helen J Lachmann; Christopher P Larsen; Heinz Ludwig; Glen S Markowitz; Giampaolo Merlini; Peter Mollee; Maria M Picken; Vincent S Rajkumar; Virginie Royal; Paul W Sanders; Sanjeev Sethi; Christopher P Venner; Peter M Voorhees; Ashutosh D Wechalekar; Brendan M Weiss; Samih H Nasr Journal: Nat Rev Nephrol Date: 2019-01 Impact factor: 28.314
Authors: Rita Alaggio; Catalina Amador; Ioannis Anagnostopoulos; Ayoma D Attygalle; Iguaracyra Barreto de Oliveira Araujo; Emilio Berti; Govind Bhagat; Anita Maria Borges; Daniel Boyer; Mariarita Calaminici; Amy Chadburn; John K C Chan; Wah Cheuk; Wee-Joo Chng; John K Choi; Shih-Sung Chuang; Sarah E Coupland; Magdalena Czader; Sandeep S Dave; Daphne de Jong; Ming-Qing Du; Kojo S Elenitoba-Johnson; Judith Ferry; Julia Geyer; Dita Gratzinger; Joan Guitart; Sumeet Gujral; Marian Harris; Christine J Harrison; Sylvia Hartmann; Andreas Hochhaus; Patty M Jansen; Kennosuke Karube; Werner Kempf; Joseph Khoury; Hiroshi Kimura; Wolfram Klapper; Alexandra E Kovach; Shaji Kumar; Alexander J Lazar; Stefano Lazzi; Lorenzo Leoncini; Nelson Leung; Vasiliki Leventaki; Xiao-Qiu Li; Megan S Lim; Wei-Ping Liu; Abner Louissaint; Andrea Marcogliese; L Jeffrey Medeiros; Michael Michal; Roberto N Miranda; Christina Mitteldorf; Santiago Montes-Moreno; William Morice; Valentina Nardi; Kikkeri N Naresh; Yasodha Natkunam; Siok-Bian Ng; Ilske Oschlies; German Ott; Marie Parrens; Melissa Pulitzer; S Vincent Rajkumar; Andrew C Rawstron; Karen Rech; Andreas Rosenwald; Jonathan Said; Clémentine Sarkozy; Shahin Sayed; Caner Saygin; Anna Schuh; William Sewell; Reiner Siebert; Aliyah R Sohani; Reuben Tooze; Alexandra Traverse-Glehen; Francisco Vega; Beatrice Vergier; Ashutosh D Wechalekar; Brent Wood; Luc Xerri; Wenbin Xiao Journal: Leukemia Date: 2022-06-22 Impact factor: 12.883
Authors: Sheng Nie; Mengyi Wang; Qijun Wan; Yaozhong Kong; Jun Ou; Nan Jia; Xiaodong Zhang; Fan Luo; Xiaoting Liu; Lin Wang; Yue Cao; Ruixuan Chen; Mingpeng Zhao; David Yiu Leung Chan; Guobao Wang Journal: Front Med (Lausanne) Date: 2021-05-24