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Clinical Epidemiology
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Rate and Predictors of Finding Monoclonal Gammopathy of Renal Significance (MGRS) Lesions on Kidney Biopsy in Patients with Monoclonal Gammopathy

Nattawat Klomjit, Nelson Leung, Fernando Fervenza, Sanjeev Sethi and Ladan Zand
JASN October 2020, 31 (10) 2400-2411; DOI: https://doi.org/10.1681/ASN.2020010054
Nattawat Klomjit
1Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
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Nelson Leung
1Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
2Division of Hematology, Mayo Clinic, Rochester, Minnesota
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Fernando Fervenza
1Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
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Sanjeev Sethi
3Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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Ladan Zand
1Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
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Significance Statement

It is not known how frequently a kidney biopsy specimen reveals monoclonal gammopathy (MG) of renal significance (MGRS) in patients with MG or what factors predict this finding. In a review of medical records of 6300 patients with MG, the authors found that only 160 (2.5%) had a biopsy. Of those, 96 (60%) had lesions unrelated to MG, with arteriosclerosis and diabetic nephropathy accounting for most cases. Among 64 patients with MGRS, amyloid light chain amyloidosis and proliferative GN with monoclonal Ig deposition were the most common lesions. An elevated serum free light chain ratio, proteinuria ≥1.5 g/d, and hematuria were the strongest independent predictors of finding MGRS on biopsy specimens. These findings will assist nephrologists in determining which patients with MG and CKD would be at high risk of having MGRS.

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.

  • MGUS
  • MGRS
  • monoclonal gammopathy of renal significance
  • monoclonal gammopathy of undetermined significance
  • renal biopsy
  • kidney biopsy
  • Copyright © 2020 by the American Society of Nephrology
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Journal of the American Society of Nephrology: 31 (10)
Journal of the American Society of Nephrology
Vol. 31, Issue 10
October 2020
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Rate and Predictors of Finding Monoclonal Gammopathy of Renal Significance (MGRS) Lesions on Kidney Biopsy in Patients with Monoclonal Gammopathy
Nattawat Klomjit, Nelson Leung, Fernando Fervenza, Sanjeev Sethi, Ladan Zand
JASN Oct 2020, 31 (10) 2400-2411; DOI: 10.1681/ASN.2020010054

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Rate and Predictors of Finding Monoclonal Gammopathy of Renal Significance (MGRS) Lesions on Kidney Biopsy in Patients with Monoclonal Gammopathy
Nattawat Klomjit, Nelson Leung, Fernando Fervenza, Sanjeev Sethi, Ladan Zand
JASN Oct 2020, 31 (10) 2400-2411; DOI: 10.1681/ASN.2020010054
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Keywords

  • MGUS
  • MGRS
  • monoclonal gammopathy of renal significance
  • monoclonal gammopathy of undetermined significance
  • renal biopsy
  • kidney biopsy

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