The prevalence and significance of monoclonal gammopathy of undetermined significance in acute medical admissions

Atkin, Catherine; Reddy‐Kolanu, Vinay; Drayson, Mark T.; Sapey, Elizabeth; Richter, Alex

doi:10.1111/bjh.16487

Cited by 19 publications

(16 citation statements)

References 30 publications

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Section: Mortalitymentioning

confidence: 93%

“…The prevalence of MGUS in those aged > 50 years was 6.94%, higher than the previously published rate of 3.2%. There were higher rates in those with chronic kidney disease heart failure, anemia, or leukocytosis [12]. Survival is somewhat dependent on the stage at diagnosis, with a 74.8% 5 year survival for those with localized disease (which only accounts for 5% of all cases) and a 52.9% for systemic MM (the remaining 95% of diagnoses) [10].…”

Section: Mortalitymentioning

confidence: 99%

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Epidemiology, Staging, and Management of Multiple Myeloma

et al. 2021

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Multiple myeloma (MM) is a plasma cell disorder that is on the rise throughout the world, especially in the US, Australia, and Western Europe. In the US, MM accounts for almost 2% of cancer diagnoses and over 2% of cancer deaths (more than double the global proportion). Incidence has risen by 126% globally and over 40% in the US since 1990, while global mortality has risen by 94% and US mortality has fallen by 18%. The 5 year survival in the US has more than doubled over the past decades with the introduction of new targeted therapies and transplant techniques. Risk factors for MM include age (average age of diagnosis is 69), race (African Americans are over double as likely to be diagnosed), sex (men are at a 1.5× risk), and family history. Diagnosis includes serum or urine electrophoresis and free light-chain assay but requires bone marrow biopsy. It is distinguished from smoldering myeloma and monoclonal gammopathy of undetermined significance by a high (>3 g/dL) level of M-protein (monoclonal light chains) and the presence of CRAB (Hypercalcemia, Renal failure, Anemia, Bone pain) symptoms, which include hypercalcemia, renal failure, anemia, and bone pain, suggesting an end-organ damage. International staging system staging involves beta 2 microglobulin and albumin levels, while the revised system considers prognostic factors such as lactate dehydrogenase levels and chromosomal abnormalities. Front-line management includes induction regimen, maintenance therapy and hematopoietic cell transplantation for eligible patients and bisphosphonates or bone-stimulating agents for the prevention of skeletal events. Treatment for relapsed disease includes newly approved monoclonal antibodies like the CD38-targeting daratumumab, proteasome inhibitors, immunomodulating agents, and investigational therapies such as B cell maturation antigen Chimeric antigen receptor T cells.

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Section: Mortalitymentioning

confidence: 93%

Section: Mortalitymentioning

confidence: 99%

Epidemiology, Staging, and Management of Multiple Myeloma

et al. 2021

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“…The global estimated prevalence of CKD is 13.4% (11.7-15.1%) (10). During the past decades, the prevalence of CKD and MG has significantly increased, especially among the elderly (11)(12)(13). Therefore, it is conceivable that some hospitalized patients with MG also have CKD, but kidney damage is not associated with MIg.…”

Section: Introductionmentioning

confidence: 99%

Kidney Biopsy in Patients With Monoclonal Gammopathy: A Multicenter Retrospective Cohort Study

et al. 2021

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Objectives: To analyze the clinical characteristics and renal pathological manifestations of patients with monoclonal gammopathy (MG) and kidney injury.Methods: This was a multicenter retrospective cohort study conducted at four tertiary hospitals in China. The study population comprised patients with MG admitted from January 1 2013 to December 31 2020. Hospitalization records, laboratory data, and kidney biopsy reports of all patients were collected from the electronic hospital information systems. The study outcomes included kidney disease progression and major hemorrhagic complications after kidney biopsy.Results: We identified 1,164 patients with MG, 782 (67.2%) of whom had underlying kidney injury. Of 101 patients who underwent kidney biopsy, 16 had malignant neoplasms. Amyloid nephropathy was the most common finding (n = 34, 33.7%), followed by membranous nephropathy (n = 18, 17.8%) and membranoproliferative nephritis (n = 8, 7.9%). Among 85 patients with non-malignant hematologic conditions who underwent kidney biopsy, 43 had MG of renal significance (MGRS) related lesions and 42 had MG-unrelated lesions. The risk of kidney disease progression was higher in patients with kidney injury than in patients without kidney injury.Conclusion: Among patients with MG and kidney injury, only 12.9% underwent kidney biopsy and more than 40% of these patients had MG-unrelated lesions. A kidney biopsy is safe and essential to maximize the possibility of correct diagnosis for patients with clinically suspected MG of renal significance (MGRS).

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“…Individuals with such “paraprotein” usually have no evidence of a systemic hematological disease, nor organ damage, such as heart failure, liver dysfunction, bone/skeletal alterations, or renal dysfunction. The prevalence of MGUS may vary from 3 to 7% in the general population, especially after the fifth decade of life, and has been, in the past, related to chronic inflammatory or infectious diseases [ 3 , 4 , 5 ]. The issue has been has been usually dealt with by regularly monitoring through laboratory tests, often for decades, without any further consequence or evidence of a clinically relevant hematologic disorder.…”

Section: Introductionmentioning

confidence: 99%

Monoclonal Gammopathies of Renal Significance: Renal Biopsy and Beyond

Menè¹,

Alexandris

Moioli

et al. 2020

Cancers

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Monoclonal Gammopathies of Renal Significance (MGRS) are a rather heterogeneous group of renal disorders caused by a circulating monoclonal (MC) immunoglobulin (Ig) component, often in the absence of multiple myeloma (MM) or another clinically relevant lymphoproliferative disorder. Nevertheless, substantial kidney damage could occur, despite the “benign” features of the bone-marrow biopsy. One example is renal amyloidosis, often linked to a small clone of plasma cells, without the invasive features of MM. However, patients with amyloidosis may present with a nephrotic syndrome and renal failure, eventually leading to end-stage kidney disease. At the same time, other organs, such as the heart and the liver, may be severely damaged by Ig light chains or amyloid deposits, occasionally resulting in fatal arrhythmias and/or organ failure. Acute kidney injury (AKI) may as well result from massive excretion of MC proteins, with deposition disease in glomeruli or renal tubules, not rarely obstructed by luminal aggregates, or “casts”. Proliferative glomerulonephritis with monoclonal Ig deposits is another, less frequent clinical presentation of an MGRS. The present review deals with the implications of MGRS for renal function and prognosis, and the potential of tools, such as the renal biopsy, for assessing clinical risk and guiding therapy of the underlying condition.

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The prevalence and significance of monoclonal gammopathy of undetermined significance in acute medical admissions

Cited by 19 publications

References 30 publications

Epidemiology, Staging, and Management of Multiple Myeloma

Epidemiology, Staging, and Management of Multiple Myeloma

Kidney Biopsy in Patients With Monoclonal Gammopathy: A Multicenter Retrospective Cohort Study

Monoclonal Gammopathies of Renal Significance: Renal Biopsy and Beyond

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