Changing Incidence of Glomerular Disease in Olmsted County, Minnesota

Swaminathan, Sundararaman; Leung, Nelson; Lager, Donna J.; Melton, L. Joseph; Bergstralh, Eric J.; Rohlinger, Audrey L.; Fervenza, Fernando C.

doi:10.2215/cjn.00710805

Cited by 225 publications

(214 citation statements)

References 13 publications

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“…The incidence of MPGN has been reported to decrease over time from about 7-10% in the 1970s to about 2% during 1990-2011 [3][4][5][6][16][17][18][19]. In the present study, among the 26,535 patients with biopsy-confirmed disease, 593 (2.2%) patients were registered as having a histopathology of MPGN types I and III.…”

Section: Discussionmentioning

confidence: 44%

“…In the clinical setting, MPGN is one of the most common causes of nephrotic syndrome in both children and adults, and accounts for approximately 2-10% of all cases of biopsy-confirmed glomerulonephritis [3][4][5][6]. Traditionally, MPGN has been classified based on the findings of electron microscopy as primary MPGN type I (MPGN I), MPGN II, MPGN III, or secondary MPGN [1,2].…”

Section: Introductionmentioning

confidence: 99%

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Clinical features and pathogenesis of membranoproliferative glomerulonephritis: a nationwide analysis of the Japan renal biopsy registry from 2007 to 2015

et al. 2017

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Background The incidence and age distribution of membranoproliferative glomerulonephritis (MPGN) vary throughout the world by race and ethnicity. We sought to evaluate the clinical features, pathogenesis, and age distribution of MPGN among a large nationwide data from the Japan Renal Biopsy Registry (J-RBR). Methods A cross-sectional survey of 593 patients with MPGN (types I and III) registered in the J-RBR between 2007 and 2015 was conducted. Clinical parameters, and laboratory findings at diagnosis were compared between children (< 20 years), adults (20-64 years), and elderly patients (≥ 65 years). Results The median age of the patients was 59.0 years and mean proteinuria was 3.7 g/day. The rate of nephrotic syndrome was significantly higher in adults (40.4%) and elderly patients (54.0%) than in children (14.9%), whereas the rate of chronic glomerulonephritis was significantly higher in children (66.2%) than in adults (34.4%) and elderly patients (31.2%). According to the CGA risk classification, high-risk (red zone) cases accounted for 3.4% of children, 52.5% of adults and 84.1% of elderly patients with MPGN. As for pathogenesis, primary MPGN was most frequent (56.0%). Lupus nephritis was the most common disease among adult patients with secondary MPGN, whereas infectious disease was more common in elderly patients. Multiple regression analysis revealed that high systolic blood pressure and high proteinuria were independent factors associated with decreased estimated glomerular filtration rate (eGFR) in adults and elderly patients with MPGN. Conclusions In Japan, adults and elderly patients with MPGN had a lower eGFR and severer proteinuria than children.

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Section: Discussionmentioning

confidence: 44%

Section: Introductionmentioning

confidence: 99%

Clinical features and pathogenesis of membranoproliferative glomerulonephritis: a nationwide analysis of the Japan renal biopsy registry from 2007 to 2015

et al. 2017

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“…In fact, MGRS cannot be established without a kidney biopsy. This is essential, because the prevalence of MG is significantly higher than the incidence of glomerular disease (46)(47)(48). Thus, the nephrotoxicity of the monoclonal protein must be confirmed before initiating treatment (49).…”

Section: How Are Mgrs-associated Nephropathies Diagnosed?mentioning

confidence: 99%

“…This can be difficult, because 5% of men and 3% of women age .70 years old will have an MG, whereas the rate of kidney disease is only 1-2 per 100,000 per year (47,62). Another study found that only 36.8% of patients with MG who underwent a kidney biopsy had a paraprotein-related kidney disease (48).…”

Section: Diagnostic Approach For Patients With Kidney Disease and An Mgmentioning

confidence: 99%

A Patient with Abnormal Kidney Function and a Monoclonal Light Chain in the Urine

Leung

Nasr

2016

CJASN

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Monoclonal gammopathy is increasingly recognized as a cause of kidney injury. These renal conditions behave differently than ones without monoclonal gammopathy and require specific treatment. To avoid misdiagnosis, testing for paraprotein should be performed in addition to vasculitis and autoimmune diseases serologies in adults with unexplained AKI or proteinuria. Because the prevalence of monoclonal gammopathy is much more common than glomerular diseases, the nephrotoxicity of the monoclonal protein must be confirmed before cytotoxic therapy is initiated. This can only be done by a kidney biopsy. After a monoclonal gammopathy of renal significant is verified, the evaluation should then focus on the identification of the pathologic clone, because therapy is clone specific. We present this patient to illustrate the clinical presentation of a patient with renal dysfunction and a monoclonal gammopathy. This patient is also used to discuss the diagnostic process in detail when monoclonal gammopathy-associated renal disease is suspected.

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“…Both high-grade proteinuria and progressive renal impairment are clear indications for renal biopsy so this is similar to non-MGRS renal diseases. It is important to note that MGUS patients outnumber patients with glomerular disease and that not all patients with renal dysfunction and a M-protein have a MGRS-related nephropathy [6,25]. On the other hand, the threshold for a renal biopsy should be lowered by the presence of a M gammopathy even in the setting of lowgrade proteinuria (1-3 g/day) in order to avoid missing the diagnosis of a MGRS-related nephropathy.…”

Section: Introductionmentioning

confidence: 99%

Laboratory testing in monoclonal gammopathy of renal significance (MGRS)

Leung

Barnidge

Hutchison³

2016

Clinical Chemistry and Laboratory Medicine (CCLM)

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Abstract:Recently, monoclonal gammopathy of renal significance (MGRS) reclassified all monoclonal (M) gammopathies that are associated with the development of a kidney disease but do not meet the definition of symptomatic multiple myeloma (MM) or malignant lymphoma. The purpose was to distinguish the M gammopathy as the nephrotoxic agent independent from the clonal mass. The diagnosis of MGRS obviously depends on the detection of the M-protein. More importantly, the success of treatment is correlated with the reduction of the M-protein. Therefore, familiarity with the M-protein tests is a must. Protein electrophoresis performed in serum or urine is inexpensive and rapid due to automation. However, poor sensitivity especially with the urine is an issue particularly with the low-level M gammopathy often encountered with MGRS. Immunofixation adds to the sensitivity and specificity but also the cost. Serum free light chain (sFLC) assays have significantly increased the sensitivity of M-protein detection and is relatively inexpensive. It is important to recognize that there is more than one assay on the market and their results are not interchangeable. In addition, in certain diseases, immunofixation is more sensitive than sFLC. Finally, novel techniques with promising results are adding to the ability to identify M-proteins. Using the time of flight method, the use of mass spectrometry of serum samples has been shown to dramatically increase the sensitivity of M-protein detection. In another technique, oligomeric LCs are identified on urinary exosomes amplifying the specificity for the nephrotoxic M-protein.

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Changing Incidence of Glomerular Disease in Olmsted County, Minnesota

Cited by 225 publications

References 13 publications

Clinical features and pathogenesis of membranoproliferative glomerulonephritis: a nationwide analysis of the Japan renal biopsy registry from 2007 to 2015

Clinical features and pathogenesis of membranoproliferative glomerulonephritis: a nationwide analysis of the Japan renal biopsy registry from 2007 to 2015

A Patient with Abnormal Kidney Function and a Monoclonal Light Chain in the Urine

Laboratory testing in monoclonal gammopathy of renal significance (MGRS)

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