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Dysproteinemias and Kidney Disease

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Onconephrology

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Abstract

Dysproteinemia is characterized by the presence of a monoclonal protein. Dysproteinemia can be associated with malignant conditions such as multiple myeloma (MM) or can be benign as in monoclonal gammopathy (MG) of undetermined significance. These terms unfortunately apply only to the proliferative properties of the clone. Independent of the proliferative potential of the clone, MGs can result in kidney disease, and are increasingly recognized as a cause for acute kidney injury as well as chronic kidney disease. A number of mechanisms have been identified for kidney injury from dysproteinemia including protein deposition, and protein-mediated tubular obstruction and complement activation. Protein deposition can be further divided by the nature of deposits, that is, organized versus non-organized deposits. These different pathologic mechanisms result in different histopathologic features and clinical presentations that can be used to separate these kidney diseases from those without MG. Confirming the association of kidney disease with MG is essential and treatment is geared toward elimination of the clone.

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Abbreviations

C3NeF:

C3 nephritic factor

CLL:

Chronic lymphocytic leukemia

CR:

Complete response

CSH:

Crystal storing histiocytosis

DDD:

Dense deposit disease

EM:

Electron microscopy

ESKD:

End stage kidney disease

GBM:

Glomerular basement membrane

FLC:

Free light chains

HCDD:

Heavy-chain deposition disease

IF:

Immunofluorescence

ITG:

Immunotactoid glomerulonephritis

LCDD:

Light-chain deposition disease

LCFS:

Light chain Fanconi syndrome

LHCDD:

Light–heavy chain deposition disease

LPL:

Lymphoplasmacytic lymphoma

MBL:

Monoclonal B-cell lymphocytosis

MCN:

Myeloma cast nephropathy

MIDD:

Monoclonal immunoglobulin deposition disease

MG:

Monoclonal gammopathy

MGRS:

Monoclonal gammopathy of renal significance

MGUS:

Monoclonal gammopathy of undetermined significance

MM:

Multiple myeloma

MPGN:

Membranoproliferative glomerulonephritis

NSAIDS:

Nonsteroidal anti-inflammatory drugs

OS:

Overall survival

PGNMID:

Proliferative glomerulonephritis with monoclonal IgG deposits

PLEX:

Plasmapheresis

SAP:

Serum amyloid P

SLL:

Small lymphocytic lymphoma

SMM:

Smoldering multiple myeloma

TBM:

Tubular basement membrane

THP:

Tamm–Horsfall protein

WM:

Waldenstrom’s macroglobulinemia

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Authors and Affiliations

  1. Department of Nephrology and Hypertension, Hematology, Mayo Clinic Rochester, 200 First Street SW, 55905, Rochester, MN, USA

    Nelson Leung MD

  2. Division of Anatomic Pathology, Mayo Clinic Rochester, 200 1st St SW, W4, 55905, Rochester, MN, USA

    Samih H. Nasr

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  1. Nelson Leung MD
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  2. Samih H. Nasr
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Correspondence to Nelson Leung MD .

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Editors and Affiliations

  1. Department of Medicine, Division of Kidney Diseases and Hypertension, North Shore University Hospital and Long Island Jewish Medical Center, Hofstra North Shore LIJ School of Medicine, Great Neck, New York, USA

    Kenar D. Jhaveri

  2. Nephrology Section, General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA

    Abdulla K. Salahudeen

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Leung, N., Nasr, S. (2015). Dysproteinemias and Kidney Disease. In: Jhaveri, K., Salahudeen, A. (eds) Onconephrology. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2659-6_13

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