Glomerulonephritis With Masked Monotypic Immunoglobulin Deposits and Concurrent Lymphomatous Infiltration

Lloyd, Isaac E.; Khalighi, Mazdak A.

doi:10.1053/j.ajkd.2016.05.012

Cited by 4 publications

(5 citation statements)

References 31 publications

(37 reference statements)

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“…Importantly, roughly 5-10% of patients with monoclonal gammopathy and findings on standard immunofluorescence (that is, conducted on frozen tissue) consistent with C3 glomerulonephritis will actually have a membranoproliferative glomerulonephritis with masked monoclonal deposits. These patients require additional immunofluorescence studies to be performed on protease-digested, paraffinembedded tissue for identification of the monoclonal immunoglobulin in the deposits 78,79 .…”

Section: Updated Classification Systemmentioning

confidence: 99%

The evaluation of monoclonal gammopathy of renal significance: a consensus report of the International Kidney and Monoclonal Gammopathy Research Group

et al. 2018

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The term monoclonal gammopathy of renal significance (MGRS) was introduced by the International Kidney and Monoclonal Gammopathy Research Group (IKMG) in 2012. The IKMG met in April 2017 to refine the definition of MGRS and to update the diagnostic criteria for MGRS-related diseases. Accordingly , in this Expert Consensus Document, the IKMG redefines MGRS as a clonal proliferative disorder that produces a nephrotoxic monoclonal immunoglobulin and does not meet previously defined haematological criteria for treatment of a specific malignancy. The diagnosis of MGRS-related disease is established by kidney biopsy and immunofluorescence studies to identify the monotypic immunoglobulin deposits (although these deposits are minimal in patients with either C3 glomerulopathy or thrombotic microangiopathy). Accordingly , the IKMG recommends a kidney biopsy in patients suspected of having MGRS to maximize the chance of correct diagnosis. Serum and urine protein electrophoresis and immunofixation, as well as analyses of serum free light chains, should also be performed to identify the monoclonal immunoglobulin, which helps to establish the diagnosis of MGRS and might also be useful for assessing responses to treatment. Finally , bone marrow aspiration and biopsy should be conducted to identify the lymphoproliferative clone. Flow cytometry can be helpful in identifying small clones. Additional genetic tests and fluorescent in situ hybridization studies are helpful for clonal identification and for generating treatment recommendations. Treatment of MGRS was not addressed at the 2017 IKMG meeting; consequently , this Expert Consensus Document does not include any recommendations for the treatment of patients with MGRS.

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Section: Updated Classification Systemmentioning

confidence: 99%

The evaluation of monoclonal gammopathy of renal significance: a consensus report of the International Kidney and Monoclonal Gammopathy Research Group

et al. 2018

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“…The first study highlighting its role in unmasking deposits reported higher sensitivity than IF-F in LCPT. 14 In this study, diagnostic kappa light chain staining of proximal tubular crystals was obtained in all 10 (100%) cases of LCPT analyzed versus only 4 (40%) cases by IF-F. 14 Several subsequent studies from Arkana Laboratories 13 , 19 , 20 , 24 and other centers 13 , 25 , 26 , 27 have highlighted an important role for IF-P as an unmasking tool. In a recent study by Stokes et al.…”

Section: Methodologies Of Paraffin Immunofluorescencementioning

confidence: 58%

“…Cases of glomerulonephritis with masked monoclonal deposits but without an MPGN pattern of injury also have been recently reported, including diffuse endocapillary proliferative and exudative glomerulonephritis (mimicking bacterial infection–associated glomerulonephritis) 25 and pure mesangial proliferative glomerulonephritis. 26 …”

Section: Methodologies Of Paraffin Immunofluorescencementioning

confidence: 99%

Paraffin Immunofluorescence: A Valuable Ancillary Technique in Renal Pathology

Nasr

Fidler

Said

2018

Kidney International Reports

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Immunofluorescence on frozen tissue is the gold standard immunohistochemical technique for evaluation of immune deposits in the kidney. When frozen tissue is not available or lacks glomeruli, immunofluorescence can be performed on paraffin tissue after antigen retrieval (paraffin immunofluorescence). Excellent results can be obtained by paraffin immunofluorescence in most immune complex–mediated glomerulonephritides and dysproteinemia-associated kidney lesions, and thus this technique has become a valuable salvage technique in renal pathology. Furthermore, new data have emerged suggesting that paraffin immunofluorescence can be used as an unmasking technique, as it is more sensitive than frozen tissue immunofluorescence in some kidney lesions, such as crystalline light chain proximal tubulopathy and is needed to establish the diagnosis of certain unique lesions, such as membranous-like glomerulopathy with masked IgG kappa deposits and membranoproliferative glomerulonephritis with masked monotypic Ig deposits. However, it is important to recognize and be aware of the limitations and pitfalls associated with paraffin immunofluorescence. These include poor sensitivity for detection of C3 deposits and for the diagnosis of primary membranous nephropathy. Here, we summarize the available techniques of paraffin immunofluorescence, review its role and performance as a salvage and unmasking technique in renal pathology, address its limitations and pitfalls, and highlight unusual forms of glomerulopathy that require paraffin immunofluorescence for diagnosis.

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“…Это выглядит как большие субэпителиальные отложения -в форме «горба». Для C3GP характерно отложение в клубочках фрагмента C3 компонента системы комплемента, по крайней мере в два раза интенсивнее, чем любая комбинация IgG, IgM, IgA и C1q [6,7,31,44,46]. Примерно у 5-10 % пациентов при иммунофлуоресцентной микроскопии обнаруживается мембранопролиферативный гломерулонефрит с замаскированными моноклональными отложениями.…”

Section: неиммуноглобулиновые гаммапатииunclassified

“…Примерно у 5-10 % пациентов при иммунофлуоресцентной микроскопии обнаруживается мембранопролиферативный гломерулонефрит с замаскированными моноклональными отложениями. Эти пациенты требуют дополнительных иммунофлуоресцентных исследований: использование протеаз для идентификации моноконального иммуноглобулина в отложениях [6,7,31,46]. При электронной микроскопии определяются электронно-плотные мезангиальные, субэпителиальные и субэндотелиальные отложения [6,7].…”

Section: неиммуноглобулиновые гаммапатииunclassified

Monoclonal Gammapathy of Renal Significance: Morphological Variants of Lesion

Фомина

Utkina

2021

Arhivʺ vnutrennej mediciny

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The article discusses the concept of monoclonal renal gammopathy, which combines various renal diseases caused by the deposition of monoclonal immunoglobulin and / or their components in the glomeruli and tubulointerstitium. This nosological group was identified within the group of monoclonal gammopathies of undetermined significance (in 2012). The data on the study of morphological kidney damage associated with monoclonal renal gammopathy are presented. The spectrum of renal diseases in monoclonal renal gammopathy is diverse, and its classification is based on the localization of renal lesions in the glomeruli, tubules, vascular interstitium and stroma, as well as the peculiarity of the deposition of immunoglobulins (organized and unorganized). Kidney biopsy is required in most cases to locate the lesion, assess its severity, and predict patient survival. Diagnostics requires the integration of morphological changes using light microscopy, immunofluorescence, electron microscopy, and in some cases, staining of monoclonal protein for Ig isotypes is used (staining with hematoxylin / eosin, Schiff stain (PAS reaction), Jones stain, Congo Red stain, Masson’s trichromal stain). Early diagnosis and timely prescription of clone-oriented therapy by a hematologist and / or a hematooncologist can stop the progression of the malignant process and kidney malfunction. A nephrologist should monitor the patient, interacting with the hematologist.

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Glomerulonephritis With Masked Monotypic Immunoglobulin Deposits and Concurrent Lymphomatous Infiltration

Cited by 4 publications

References 31 publications

The evaluation of monoclonal gammopathy of renal significance: a consensus report of the International Kidney and Monoclonal Gammopathy Research Group

The evaluation of monoclonal gammopathy of renal significance: a consensus report of the International Kidney and Monoclonal Gammopathy Research Group

Paraffin Immunofluorescence: A Valuable Ancillary Technique in Renal Pathology

Monoclonal Gammapathy of Renal Significance: Morphological Variants of Lesion

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