Long-term outcome according to renal histological lesions in 118 patients with monoclonal gammopathies

Montseny, Jean-Jacques; Kleinknecht, D; Meyrier, Alain; Vanhille, Philippe; Simon, Pierre; Pruna, Alain; Eladari, Dominique

doi:10.1093/ndt/13.6.1438

Cited by 154 publications

(126 citation statements)

References 2 publications

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“…The mean age was 56 years; 36% of patients were #50 years of age and only 22% were elderly (.64 years of age). In comparison, the reported mean age at diagnosis was 66 years for MCN (11) and 62 years for light chain amyloidosis (12). Therefore, in patients with dysproteinemia, the chance of finding pure MIDD and not amyloid or MCN is higher in middle-aged adults compared with the elderly population.…”

Section: Discussionmentioning

confidence: 97%

Renal Monoclonal Immunoglobulin Deposition Disease

Nasr¹,

Valeri²,

Cornell³

et al. 2012

Clinical Journal of the American Society of Nephrology

250

214

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SummaryBackground and objectives To better define the clinical-pathologic spectrum and prognosis of monoclonal immunoglobulin deposition disease (MIDD), this study reports the largest series.Design, setting, participants, & measurements Characteristics of 64 MIDD patients who were seen at Mayo Clinic are provided.Results Of 64 patients with MIDD, 51 had light chain deposition disease, 7 had heavy chain deposition disease, and 6 had light and heavy chain deposition disease. The mean age at diagnosis was 56 years, and 23 patients (36%) were #50 years of age. Clinical evidence of dysproteinemia was present in 62 patients (97%), including multiple myeloma in 38 (59%). M-spike was detected on serum protein electrophoresis in 47 (73%). Serum free light chain ratio was abnormal in all 51 patients tested. Presentation included renal insufficiency, proteinuria, hematuria, and hypertension. Nodular mesangial sclerosis was seen in 39 patients (61%). During a median of 25 months of follow-up (range, 1-140) in 56 patients, 32 (57%) had stable/improved renal function, 2 (4%) had worsening renal function, and 22 (39%) progressed to ESRD. The mean renal and patient survivals were 64 and 90 months, respectively. The disease recurred in three of four patients who received a kidney transplant.Conclusions Patients with MIDD generally present at a younger age than those with light chain amyloidosis or light chain cast nephropathy. Serum free light chain ratio is abnormal in all MIDD patients, whereas only threequarters have abnormal serum protein electrophoresis. The prognosis for MIDD is improving compared with historical controls, likely reflecting earlier detection and improved therapies.

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Section: Discussionmentioning

confidence: 97%

Renal Monoclonal Immunoglobulin Deposition Disease

Nasr¹,

Valeri²,

Cornell³

et al. 2012

Clinical Journal of the American Society of Nephrology

250

214

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“…Evidence of renal insufficiency is identified in approximately 20%-40% of patients newly diagnosed with multiple myeloma, and it is an independent predictor for increased morbidity and mortality (24,25). Cast nephropathy (also known as myeloma kidney) is the most common presentation of AKI related to multiple myeloma and the most common histologic lesion in renal biopsies of patients with monoclonal gammopathies (26). Under normal physiologic conditions, immunoglobulin light chains are freely filtered by the glomerulus and taken up by tubular cells by cubilin/megalin receptors and clathrindependent endocytosis, where they are subsequently degraded in lysosomes ( Figure 2) (27).…”

Section: Intrinsic Causesmentioning

confidence: 99%

Onco-Nephrology

Lam

Humphreys

2012

Clinical Journal of the American Society of Nephrology

111

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SummaryAKI is common in patients with cancer, and it causes interruptions in therapy and increased hospital length of stay, cost, and mortality. Although cancer patients are susceptible to all of the usual causes of AKI in patients without cancer, there are a number of AKI syndromes that occur more frequently or are unique to this patient population. AKI also confers substantially increased risk of short-term death, and the ability to reverse AKI portends a better outcome in some cancers, such as multiple myeloma. Several trends in oncology, including increased survival, better supportive care, older patients who have received multiple chemotherapy regimens, and new therapeutic options, are driving an increase in the numbers of cancer patients who develop AKI. As a result, nephrologists should be increasingly familiar with the diagnosis, management, and treatment of AKI in this setting. Here, we summarize recent data on epidemiology of AKI in cancer patients, describe the most common AKI syndromes in this population, and highlight emerging areas in the growing field of onconephrology.

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“…(7%-30%; Montseny et al, 1998). Renal affection and remaining function have an important impact on the prognosis of the patient.…”

mentioning

confidence: 99%

Lymphangiogenesis Is Upregulated in Kidneys of Patients With Multiple Myeloma

Zimmer

Dahdal

Mühlfeld

et al. 2010

The Anatomical Record

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Neolymphangiogenesis has recently been demonstrated in transplanted kidneys as well as in chronic interstitial nephritis and IgA nephropathy. However, its significance in kidney disease remains to be defined and a systematic study of renal lymphangiogenesis is warranted. We investigated patients with multiple myeloma (MM) presenting in the great majority with acute renal insufficiency. Controls were allograft kidney donors and patients with renal insufficiency due to acute renal failure (ARF). Lymph vessel length density (LVD) was quantified immunohistochemically by means of antipodoplanin staining followed by computer-assisted stereology. The mean LVD in kidneys of patients with MM (23.19 mm À2 ) was higher when compared with allograft donors (7.42 mm À2 , P ¼ 0.0003) and patients with ARF (6.78 mm À2 , P ¼ 0.0002). The higher LVD was significantly associated with interstitial inflammation, and the newly formed lymph vessels were accompanied by diffuse and nodular interstitial infiltrates composed mainly of CD20 þ B cells and CD27 þ plasma cells. The infiltrates in patients with MM also displayed a higher expression of the B-cell chemoattractant CXCL13. These results demonstrate for the first time that lymphangiogenesis is a prominent feature in MM kidneys and that it is associated with a significant accumulation of macrophages, CD20 þ and CD27 þ B lymphocytes. Further studies should clarify whether these changes represent a beneficial or detrimental factor in the progression of the myeloma-related kidney damage. Anat Rec, 293:1497Rec, 293: -1505

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Long-term outcome according to renal histological lesions in 118 patients with monoclonal gammopathies

Cited by 154 publications

References 2 publications

Renal Monoclonal Immunoglobulin Deposition Disease

Renal Monoclonal Immunoglobulin Deposition Disease

Onco-Nephrology

Lymphangiogenesis Is Upregulated in Kidneys of Patients With Multiple Myeloma

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