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Between 2013 and 2018, we identified 132 patients with a renal biopsy. Of these, 35 (27%) had an MGRS lesions. The most common MGRS lesions included proliferative glomerulonephritis with monoclonal immunoglobulin deposition (n¼12, 34%), light chain proximal tubulopathy (n¼6, 17%) and light chain deposition disease (n¼5m 14%). In the remaining 97 patients, the most common lesions included arteriosclerosis (n¼22, 23%), diabetic nephropathy (n¼16, 17%) and ANCA associated vasculitis (n¼11, 11%). Having a combination of hematuria and proteinuria$2 g/day (identified as high risk features) was the most significant predictor with an OR of 3.86 (1.56-9.55, p<0.01). Other important predictors include hematuria at time of the biopsy OR 3.18 (1.40, 7.23, p<0.01) and proteinuria OR 1.15 (1.03, 1.19, p¼0.04).Conclusions: This study shows that in patient with CKD, majority of patient have monoclonal gammopathy of undetermined significance (MGUS) and rate of true MGRS is quite low. Presence of hematuria in combination with proteinuria >2 grams is highly predictive of finding and MGRS lesion and perhaps renal biopsy should be reserved for such patients.

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