Association of primary renal non-Hodgkin's lymphoma with mesangioproliferative glomerulonephritis

Zahner, J; Gerharz, C. D.; Bach, Dieter; Heer-Sonderhoff, A. H.; Winkelmann, M; Grabensee, B; Schneider, Wolfgang

doi:10.1002/(sici)1096-8652(199610)53:2<126::aid-ajh12>3.0.co;2-d

Cited by 10 publications

(6 citation statements)

References 53 publications

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“…Glomerulonephritis with membranoproliferative-like patterns and M-immunoglobulin deposition disease were the most common histological findings in this group of patients. Similar to the literature, glomerular involvement with membranoproliferative glomerulonephritis [28,28,29] and M-protein deposition disease [30][31][32] was common in patients with NHL. [33,34] AL amyloidosis represented only a small percentage (8.9%) of all monoclonal gammopathies.…”

Section: Discussionsupporting

confidence: 84%

“…The majority of patients (89.1%) was admitted with a severe and acute worsening of renal function that required renal replacement treatment in about a third of cases. In line with previous native renal biopsy studies 24,25 , cast nephropathy was the most prevalent histopathological finding 28,28,29 and M-protein deposition disease [30][31][32] was common in patients with NHL 33,34 .…”

Section: Discussionsupporting

confidence: 84%

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Clinical Presentation, Renal Histopathological Findings and Outcome in Patients with Monoclonal Gammopathy and Kidney Disease

Delrio

Fontana²,

Ferrari

et al. 2020

Preprint

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Monoclonal gammopathies have been widely associated with renal lesions. Nephrotoxicity of the secreted monoclonal (M)-protein relies on a complex interplay between biological characteristics and serum concentration. Little is known about the prevalence and renal manifestations of the different types of monoclonal gammopathies in patients with kidney disease. We reviewed all renal biopsies in our Center during a 12-year period to characterize patients diagnosed with monoclonal gammopathy. Data about demographics, laboratory examinations, renal manifestations and histological lesions were collected retrospectively. Results were correlated with the different lymphoproliferative disorders to evaluate the relationship between renal involvement and monoclonal gammopathies. Monoclonal gammopathies have been associated with kidney injury. Nephrotoxicity of the secreted monoclonal (M)-protein relies on a complex interplay between biological characteristics and serum concentration. Little is known about the epidemiology and clinical manifestations of the different types of monoclonal gammopathies in patients with kidney disease. We enrolled all patients with monoclonal gammopathy who underwent kidney biopsy between January 2000 and March 2017. Data about demographics, clinical manifestations and histological lesions were collected retrospectively. Monoclonal gammopathy was detected in 174 (13%) patients with a mean age of 66.4±13.1 years. M-protein was secreted by monoclonal gammopathy of undetermined significate (MGUS) (52,8%), myeloma multiple (MM) (25.2%), primary amyloidosis (AL) (9,1%), smoldering MM (7 %), non-Hodgkin lymphoma (NHL) (6.8%) and HL (1.7%). Monoclonal gammopathy of renal significance (MGRS) accounted for 6.5% in patients with MGUS and 14.2% in patients with smoldering MM. Evaluation of kidney biopsy revealed that M-protein was directed involved in causing kidney injury in MM (93.1%) and NHL (8,3%). MM was the only gammopathy significantly associated with an increased risk of kidney injury (odds ratio [OR]=47.5, CI95%, 13.7-164.9; P≤0.001). While there were no significant differences in the progression toward end-stage renal disease or dialysis (P=0.776), these disorders were associated with a different risk of death (P=0.047) at the end of the follow-up. Monoclonal gammopathy was a frequent finding in patients with kidney disease. Kidney biopsy had a key role in identifying the underlying monoclonal gammopathy and recognizing the causal relationship between M-protein and kidney injury.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionsupporting

confidence: 84%

Clinical Presentation, Renal Histopathological Findings and Outcome in Patients with Monoclonal Gammopathy and Kidney Disease

Delrio

Fontana²,

Ferrari

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…Glomerulonephritis with membranoproliferative-like patterns and M-immunoglobulin deposition disease were the most common histological findings in this group of patients. Similar to the literature, glomerular involvement with membranoproliferative glomerulonephritis [26,27] and M-protein deposition disease [9,28,29] was common in patients with NHL [9,30]. AL amyloidosis represented only a small percentage (8.9%) of all monoclonal gammopathies.…”

Section: Discussionsupporting

confidence: 79%

Clinical Presentation, Renal Histopathological Findings, and Outcome in Patients with Monoclonal Gammopathy and Kidney Disease

Delrio

Fontana

Mori

et al. 2021

International Journal of Nephrology

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Monoclonal gammopathies are associated with acute and chronic kidney injury. Nephrotoxicity of the secreted monoclonal (M)-protein is related to its biological properties and blood concentration. Little is known about epidemiology, clinical manifestations, and outcome of monoclonal gammopathies in patients with kidney disease. We retrospectively collected data about demographics, clinical manifestations, and renal histological lesions of all patients (n = 1334) who underwent kidney biopsy between January 2000 and March 2017. Monoclonal gammopathy was detected in 174 (13%) patients with a mean age of 66.4 ± 13.1 years. The spectrum of monoclonal gammopathies comprised monoclonal gammopathy of undetermined significate (MGUS) (52.8%), multiple myeloma (MM) (25.2%), primary amyloidosis (AL) (9.1%), smoldering MM (SMM) (4%), non-Hodgkin lymphoma (NHL) (6.8%), and Hodgkin lymphoma (HL) (1.7%). Monoclonal gammopathy of renal significance (MGRS) accounted for 6.5% in patients with MGUS and 14.2% in patients with SMM. Evaluation of kidney biopsy revealed that M-protein was directly involved in causing kidney injury in MM (93.1%). MM was the only gammopathy significantly associated with an increased risk of kidney injury (odds ratio [OR] = 47.5, CI 95%, 13.7–164.9; P ≤ 0.001 ). While there were no significant differences in the progression toward end-stage renal disease or dialysis P = 0.776 , monoclonal gammopathies were associated with a different risk of death P = 0.047 at the end of the follow-up. In conclusion, monoclonal gammopathy was a frequent finding (13%) in patients who underwent kidney biopsy. M-protein was secreted by both premalignant (56.8%) and malignant (43.2%) lymphoproliferative clones. Kidney biopsy had a key role in identifying MGRS in patients with MGUS (6.5%) and SMM (14.2%). Among monoclonal gammopathies, only MM was significantly associated with biopsy-proven kidney injury. The rate of end-stage renal disease or dialysis was similar among monoclonal gammopathies, whereas NHL, MM, and SMM showed a higher rate of deaths.

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“…Polymerisation and depolymerisation of tubulin is a complex and well-controlled process involving the binding of GDP, GTP and microtubule-associated proteins [41,42]. The beneficial effects of vincristine in nephrotic syndrome, particularly when associated with haematological malignancy, have been noted for many years [43][44][45][46][47][48][49][50][51]. This latter group of patients is, however, heterogeneous and only some have histological features of FSGS underlying the nephrotic syndrome.…”

Section: Discussionmentioning

confidence: 99%

Vincristine and focal segmental sclerosis: do we need a multicentre trial?

Goonasekera

Koziell

Hulton

et al. 1998

Pediatric Nephrology

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Over the last 10 years, eight children have received vincristine for the treatment of steroid- and cyclophosphamide-resistant nephrotic syndrome at Great Ormond Street Hospital for Children, London. We present our experience of these eight cases and put forward a case for reassessing the effectiveness of vincristine in this disorder. In our series, two children treated with vincristine achieved complete remission with preserved renal function, including relapses in one. Both had primary steroid- and cyclophosphamide-resistant focal segmental glomerulo sclerosis (FSGS). Of the other cases, four also had primary FSGS, one familial FSGS and one mesangioproliferative glomerulonephritis. We discuss in general the pros and cons of vincristine therapy in nephrotic syndrome versus the cytotoxic agents that are currently used and the differences in clinical features among the responders and non-responders in this small group. In addition, we explore why this may have occurred and summarise the literature over the last 25 years, where vincristine appeared to have been beneficial, especially in secondary forms of nephrotic syndrome associated with malignancy. We conclude that vincristine therapy warrants re-examination as it could be a valuable alternative therapeutic agent in some cases of FSGS with relatively minor side effects.

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Association of primary renal non-Hodgkin's lymphoma with mesangioproliferative glomerulonephritis

Cited by 10 publications

References 53 publications

Clinical Presentation, Renal Histopathological Findings and Outcome in Patients with Monoclonal Gammopathy and Kidney Disease

Clinical Presentation, Renal Histopathological Findings and Outcome in Patients with Monoclonal Gammopathy and Kidney Disease

Clinical Presentation, Renal Histopathological Findings, and Outcome in Patients with Monoclonal Gammopathy and Kidney Disease

Vincristine and focal segmental sclerosis: do we need a multicentre trial?

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