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Histological Findings in Kidney Biopsies of Patients with Monoclonal Gammopathy—Always a Surprise

Background: The simultaneous occurrence of impaired kidney function and paraproteinemia is common in our constantly aging society. Both can be independent entities; however, renal insufficiency can also be caused by the paraprotein. We assessed all kidney biopsies in patients with monoclonal gammopa...

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Autores principales: Klank, David, Hoffmann, Martin, Porubsky, Stefan, Bergner, Raoul
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9406481/
https://www.ncbi.nlm.nih.gov/pubmed/36010261
http://dx.doi.org/10.3390/diagnostics12081912
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author Klank, David
Hoffmann, Martin
Porubsky, Stefan
Bergner, Raoul
author_facet Klank, David
Hoffmann, Martin
Porubsky, Stefan
Bergner, Raoul
author_sort Klank, David
collection PubMed
description Background: The simultaneous occurrence of impaired kidney function and paraproteinemia is common in our constantly aging society. Both can be independent entities; however, renal insufficiency can also be caused by the paraprotein. We assessed all kidney biopsies in patients with monoclonal gammopathy in our clinic over the past 20 years and evaluated the histological results. Methods: Biopsies were systematically performed in nearly all patients with paraproteinemia and impaired kidney function (n = 178). The histological findings were systematically evaluated and correlated with the initial clinical diagnosis. Results: We found cast nephropathy (CN) in n = 66 (37.1%) biopsies, AL amyloidosis in n = 31 (17.4%) biopsies, monoclonal immunoglobulin deposition disease (MIDD) in n = 7 (3.9%) biopsies and other renal diseases (ORDs) in n = 74 (41.6%) biopsies. In the latter group, paraprotein-associated changes were found in 37 of 74 (50%) patients, whereas paraprotein-independent changes were found in the other half. Whereas, in the group of patients with MGUS, the findings were heterogenous, most of the patients with known multiple myeloma (MM) or B-NHL showed malignancy-associated changes in the kidney. The biopsy changed the diagnoses in a significant proportion of the patients: The group of patients with MM grew from 71 to 112 patients, whereas, in the MGUS group, only 31 of 44 patients remained. Conclusion: Kidney biopsies in patients with paraproteinemia and renal impairment show a wide range of findings that can lead to a change in diagnosis.
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spelling pubmed-94064812022-08-26 Histological Findings in Kidney Biopsies of Patients with Monoclonal Gammopathy—Always a Surprise Klank, David Hoffmann, Martin Porubsky, Stefan Bergner, Raoul Diagnostics (Basel) Article Background: The simultaneous occurrence of impaired kidney function and paraproteinemia is common in our constantly aging society. Both can be independent entities; however, renal insufficiency can also be caused by the paraprotein. We assessed all kidney biopsies in patients with monoclonal gammopathy in our clinic over the past 20 years and evaluated the histological results. Methods: Biopsies were systematically performed in nearly all patients with paraproteinemia and impaired kidney function (n = 178). The histological findings were systematically evaluated and correlated with the initial clinical diagnosis. Results: We found cast nephropathy (CN) in n = 66 (37.1%) biopsies, AL amyloidosis in n = 31 (17.4%) biopsies, monoclonal immunoglobulin deposition disease (MIDD) in n = 7 (3.9%) biopsies and other renal diseases (ORDs) in n = 74 (41.6%) biopsies. In the latter group, paraprotein-associated changes were found in 37 of 74 (50%) patients, whereas paraprotein-independent changes were found in the other half. Whereas, in the group of patients with MGUS, the findings were heterogenous, most of the patients with known multiple myeloma (MM) or B-NHL showed malignancy-associated changes in the kidney. The biopsy changed the diagnoses in a significant proportion of the patients: The group of patients with MM grew from 71 to 112 patients, whereas, in the MGUS group, only 31 of 44 patients remained. Conclusion: Kidney biopsies in patients with paraproteinemia and renal impairment show a wide range of findings that can lead to a change in diagnosis. MDPI 2022-08-07 /pmc/articles/PMC9406481/ /pubmed/36010261 http://dx.doi.org/10.3390/diagnostics12081912 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Klank, David
Hoffmann, Martin
Porubsky, Stefan
Bergner, Raoul
Histological Findings in Kidney Biopsies of Patients with Monoclonal Gammopathy—Always a Surprise
title Histological Findings in Kidney Biopsies of Patients with Monoclonal Gammopathy—Always a Surprise
title_full Histological Findings in Kidney Biopsies of Patients with Monoclonal Gammopathy—Always a Surprise
title_fullStr Histological Findings in Kidney Biopsies of Patients with Monoclonal Gammopathy—Always a Surprise
title_full_unstemmed Histological Findings in Kidney Biopsies of Patients with Monoclonal Gammopathy—Always a Surprise
title_short Histological Findings in Kidney Biopsies of Patients with Monoclonal Gammopathy—Always a Surprise
title_sort histological findings in kidney biopsies of patients with monoclonal gammopathy—always a surprise
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9406481/
https://www.ncbi.nlm.nih.gov/pubmed/36010261
http://dx.doi.org/10.3390/diagnostics12081912
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