Onco-Nephrology

Cambier, J; Ronco, Pierre

doi:10.2215/cjn.03770412

Cited by 92 publications

(86 citation statements)

References 91 publications

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“…On the other hand, paraproteinemic proximal tubular injury, including crystal-storing hystiocytosis and LCPT with or without Fanconi syndrome, and causative for acute tubular necrosis and AKI [13,18,22,37], is almost invariably associated with monoclonal LC κ, and only rarely with Ig heavy chains [44], like in our case. As no crystals were found by electron microscopy, and the patient did not demonstrate clinical features of Fanconi syndrome, we presume that she has non-crystalline form of proximal heavy and light chain tubulopathy without Fanconi syndrome, causing repeated episodes of AKI.…”

Section: Discussionmentioning

confidence: 60%

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Combined immunoglobulin G kappa nephropathy: monoclonal immunoglobulin deposition disease and proximal tubulopathy: monoclonal gammopathy of renal significance or smoldering multiple myeloma? Case report and review of literature

Zakharova¹,

Stolyarevich²,

Vorobyeva³

et al. 2017

Integr Cancer Sci Therap.

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Multiple myeloma (MM) is consistently preceded by precursor states of monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM). These represent a continuum of progression of the tumor burden from the absence of symptoms or signs of end-organ damage towards full-blown symptomatic disease. MGUS, by definition presenting by monoclonal gammopathy without end organ damage, in fact might be associated with the numerous end organ lesions, first of all pathologic renal conditions. The term monoclonal gammopathy of renal significance (MGRS) was proposed by International Kidney and Monoclonal Gammopathy Research Group in order to discriminate the pathologic nature of these diseases from the truly benign MGUS. Spectrum of MGRS, caused by the deposition of monoclonal immunoglobulin's or fragments thereof as organized and non-organized deposits, includes more commonly AL amyloidosis, monoclonal immunoglobulin deposition disease (MIDD) and light-chain proximal tubulopathy (LCPT). Same variants are seen in patients with MM and SMM. We present a rare case of combined immunoglobulin G kappa nephropathy: MIDD and proximal tubulopathy in a patient, manifested with acute kidney injury and diagnosed with SMM after 6 years of scrutinous repeated evaluation. . BackgroundMultiple myeloma (MM) is a plasma-cell dyscrasia presenting with generalized neoplastic changes in bones, accompanied by impaired haematopoiesis and susceptibility to infections. The diagnosis is based on histologic, serologic, and radiographic features: bone marrow clonal plasma cells; monoclonal protein in the serum or urine; and end-organ damage, evidenced by renal impairment, hypercalcemia, anemia, or lytic bone lesions. Monoclonal gammopathy of undermined significance (MGUS) is a pre-malignant disorder, characterized by presence of monoclonal gammopathy without end organ damage. MGUS tend to progress over time to MM, lymphoproliferative disorders and AL amyloidosis with the rate about 1% per year. Asymptomatic or smoldering multiple myeloma (SMM) is a heterogeneous clinical entity where a subset of patients has an indolent course that mimics MGUS, whereas others have a more aggressive course that has been described as "early myeloma". MM is consistently preceded by precursor states of MGUS and SMM, these represent a continuum of progression of the tumor burden from the absence of symptoms or signs of end-organ damage towards full-blown symptomatic disease [1][2][3][4][5][6][7][8].Renal damage in MM is mainly caused by the deposition of monoclonal immunoglobulin's (Ig) or fragments thereof as organized (casts, crystals, fibrils, microtubules) and non-organized deposits, involving all compartments of the renal parenchyma: glomeruli,

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Section: Discussionmentioning

confidence: 60%

“…injury (AKI) and chronic kidney disease (CKD) to nephrotic syndrome (NS) and renal tubular disturbances [9][10][11][12][13][14][15][16][17][18][19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Combined immunoglobulin G kappa nephropathy: monoclonal immunoglobulin deposition disease and proximal tubulopathy: monoclonal gammopathy of renal significance or smoldering multiple myeloma? Case report and review of literature

Zakharova¹,

Stolyarevich²,

Vorobyeva³

et al. 2017

Integr Cancer Sci Therap.

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“…17 In our sample, 4 patients had also been diagnosed with leukemia, lymphoma or myeloma: 3 in the immunoglobulin positive group and 1 in the C3 positive group. Larsen et al 18 described MPGN related to dysproteinemia patients with negative monoclonal immunoglobulin deposits that were unmasked only after performing immunofluorescence on formalin-fixed paraffin embedded tissue after protease digestion.…”

Section: Follow-upmentioning

confidence: 81%

Clinical and histological features of patients with membranoproliferative glomerulonephritis classified by immunofluorescence findings

Dias¹,

Testagrossa²,

Jorge³

et al. 2017

Jornal Brasileiro De Nefrologia

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“…Pathology data (Table 2) showed that kidney damage in patients with NHL/CLL and LPCL presented with 11 different patterns described in the literature [4][5][6][7][8][9][10][11][12][13]. Glomerulonephritis comprised almost half of cases and was found in 11 (45.8%) of patients, in 4 cases GN was associated with monoclonal paraproteins, and in 7 cases was considered to be paraneoplastic.…”

Section: Pathology Findingsmentioning

confidence: 96%

“…Pathology patterns (Table 1) include interstitial or glomerular specific infiltration; cryoglobulinemic GN (CryoGN); proliferative (PGNMID) and non-proliferative GN with monoclonal immunoglobulin deposits; immunotactoid (GOMMID) and fibrillary GN; paraneoplastic GN -mostly membranous nephropathy (MN) and membranoproliferative GN (MPGN); AL/AH amyloidosis, and even AA amyloidosis [4][5][6][7][8][9][10][11][12][13]. In turn, MN and MPGN are known to be often secondary to lymphomas, and immunotactoid and fibrillary GN, defined by electron microscopy (EM), may present like MN and MPGN by light microscopy (LM) evaluation [14][15][16].…”

Section: Drug-induced Nephritismentioning

confidence: 99%

Clinical Presentation and Pathology Spectrum of Kidney Damage in Nonhodgkin Lymphoma/Leukemia and Lymphoplasmacytic Lymphomas

Ev¹,

Es²

2015

J Leuk

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Kidney damage in non-Hodgkin lymphoma/leukemia (NHL/CLL) and lymphoplasmacytic lymphomas (LPCL) are caused by several mechanisms: tumor mass localization; clonal cell expansion; hormones, cytokines and growth factors secretion; metabolic, electrolyte and coagulation disturbances; deposition of paraproteins and treatment complications. Symptoms of kidney damage may dominate and even preclude overt NHL/CLL or LPCL, and only renal pathology findings give the clue to the diagnosis. We aimed to evaluate clinical presentation and pathology of kidney damage in patients with NHL/CLL or LPCL. Using electronic database and purposely designed chart, we searched data for 158 patients with lymphoproliferative disorders (LPD) and pathology proven kidney lesions. Patients with multiple myeloma, Hodgkin's lymphoma, Castleman disease, "primary" AL amyloidosis and "primary" light chain deposition disease were excluded from further analysis. Study group consisted of 24 patients, 14 (58.3%) male and 10 (41.7%) female, median age 67 (17;76) years. 16 patients (66.6%) were diagnosed with NHL/CLL, 7 patients (29.1%) with Waldenström's Macroglobulinemia (WM) and 1 (4.1%) with Franklin's disease (FD). 10 (41.7%) of patients presented with nephrotic syndrome (NS), 17 (70.8%)-with impaired kidney function, and 6 (25.2%) with both NS and renal dysfunction. By pathology glomerulonephritis (GN) was found in 11 (45.8%) of patients, in 4 cases GN pattern was associated with monoclonal paraproteins, and in 7 cases GN was considered to be paraneoplastic. Interstitial nephritis was seen in 10 (41.6%) patients, in 8 of them due to specific lymphoid infiltration; and amyloidosis complicated only 3 (12.5%) cases. Patients with NHL/CLL or LPCL, presenting with renal abnormalities, show variety of pathology patterns hardly predictable on clinical basis. Most often in our patient series was specific lymphoid interstitial infiltration and paraneoplastic glomerulonephritis with MN and MPGN patterns. In many cases of NS and/or acute kidney injury (AKI) renal biopsy was crucial for the diagnosis of NHL/CLL and LPCL.

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Onco-Nephrology

Cited by 92 publications

References 91 publications

Combined immunoglobulin G kappa nephropathy: monoclonal immunoglobulin deposition disease and proximal tubulopathy: monoclonal gammopathy of renal significance or smoldering multiple myeloma? Case report and review of literature

Combined immunoglobulin G kappa nephropathy: monoclonal immunoglobulin deposition disease and proximal tubulopathy: monoclonal gammopathy of renal significance or smoldering multiple myeloma? Case report and review of literature

Clinical and histological features of patients with membranoproliferative glomerulonephritis classified by immunofluorescence findings

Clinical Presentation and Pathology Spectrum of Kidney Damage in Nonhodgkin Lymphoma/Leukemia and Lymphoplasmacytic Lymphomas

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